Global Warming
 - Question

Baroness Sheehan: To ask Her Majesty’s Government further to the finding by the Mauna Loa Observatory that carbon dioxide in the atmosphere reached 419 parts per million in May 2021, what advice they have received from their Chief Scientific Adviser about the implications of global warming for the United Kingdom.

Lord Callanan: Her Majesty’s Government and advice from their Chief Scientific Adviser are informed by the latest scientific evidence as presented by the Intergovernmental Panel on Climate Change. The panel’s report set out how, as carbon dioxide concentrations in the atmosphere rise, global temperatures are also expected to rise, with severe impacts globally. Risks to the UK are assessed in the UK’s climate change risk assessments, which are informed by the Climate Change Committee’s independent assessments.

Baroness Sheehan: I thank the Minister for his reply. The figure of 419 parts per million is the highest ever recorded over the last 800,000 years and it is a direct indicator, based on hard science, of a rapidly changing climate and consequent irreversible damage to our ecosystems. The BBC reports that in January 2020 some hard science was presented to the Prime Minister in the form of a slide show at a teach-in organised by Sir Patrick Vallance and led by Professor Stephen Belcher of the Met Office. It is said to have convinced the Prime Minister to take climate change seriously and that must mean keeping fossil fuels in the ground. Was the Minister present and will he ask for a similar teach-in for all government departments?

Lord Callanan: No, I was not present, but we have regular meetings with all the advisers who inform government policy on this matter. I know the noble Baroness has a strong view about “leaving fossil fuels in the ground”, but we require gas as a transition fuel. In the context of the recent crisis in Ukraine, surely even the noble Baroness can see the logic of obtaining that transitional fuel from UK sources.

Baroness Boycott: My Lords, in 2020 BEIS set up a committee to look at and collaborate on policy development to ensure that individual policies were joined up across government—surely a good move. That committee was disbanded in May 2021. May I ask the Minister two questions? What has replaced that committee as a cross-government body to oversee  climate considerations in all departments? If that committee is the one chaired by the Prime Minister, when did it last meet and are we allowed to know what it discussed?

Lord Callanan: There is a Cabinet committee on climate change chaired by the Prime Minister dealing with cross-government issues. The noble Baroness will be aware individual Cabinet committee meetings are confidential, but she can be assured that there is regular collaborative cross-government working between departments on all these issues.

Baroness Ritchie of Downpatrick: My Lords, the Thwaites Glacier in western Antarctica is collapsing into the sea, which could raise sea levels by as much as 10 feet if the whole ice sheet falls. In such circumstances, have the Government undertaken an assessment of the likely impact that this would have on coastal communities in the UK and on vulnerable areas around the world?

Lord Callanan: The Government’s third climate change risk assessment sets out 61 risks and opportunities facing the UK from climate change, with eight priority risk areas identified as requiring action within the next two years. Action already taken includes £5.2 billion in 2021 for flood and coastal defences.

Baroness Blackstone: My Lords, following the IPCC report, mentioned by the noble Baroness, Lady Sheehan, on the damage to our ecosystem, can the Minister update the House on what further work is being done to engage the public on climate change and biodiversity issues? I think he agrees with me that evidence shows that, if these issues are understood, far more people are willing to change the way they live to reduce the impact of climate change.

Lord Callanan: My Lords, I agree with the noble Baroness; of course, we regularly undertake public information activities. The public are well aware of the risks presented by climate change and there is wide public support for action.

Lord West of Spithead: My Lords, does the Minister agree that these concerns make it even more imperative that we press ahead with our plans for getting more nuclear power, and that anyone opposing that has no idea of what the risks are?

Lord Callanan: On this, as with so many issues, I totally agree with the noble Lord; he should, perhaps, be on this side of the House. The noble Lord is, of course, absolutely right. We need to expand our nuclear power provisions and I am delighted that we have the support of the Official Opposition for our Nuclear Energy (Financing) Bill, which is shortly to come back to the House.

Baroness Janke: My Lords, do the Government plan to take any action to ensure that factually incorrect statements made in your Lordships’ House are corrected, either at the time they are made or subsequently, given that the science behind climate change is incontrovertible?

Lord Callanan: Individual Members are responsible for their own statements and opinions. This is a debating House, in which there are strongly held opinions on all sides, but if any Member, whether in government or otherwise, gets something factually wrong, I am sure they would want to correct the record.

Baroness Hayman of Ullock: My Lords, this week’s IPCC report suggests increasingly severe climate impacts, with warnings that heatwaves and flooding are highly likely, including in the UK. Firefighters are the primary public service responding to flooding in the UK; heatwaves can cause wildfires, which firefighters increasingly face. Yet our fire and rescue service has seen huge cuts, including one in every five firefighters since 2010. What plans do the Government have to fully support those in our emergency services who have to deal with the increasing numbers of catastrophic events?

Lord Callanan: My Lords, the noble Baroness makes an important point. Of course we want to support workers in our emergency services, who do such a tremendous job. We saw some of that during the recent flooding: they are the first line of our defence, and we should support them in every way that we can.

Lord Foulkes of Cumnock: My Lords, the Minister mentioned the Nuclear Energy (Financing) Bill. He will be aware from an intervention that I made previously that many of us are concerned that the Scottish Government might be able to use planning laws to thwart the development of new nuclear in Scotland. Is it not the case that, if this is vital for the security and diversity of energy supply for the whole United Kingdom, there must be some way in which the United Kingdom can make sure that new nuclear can extend to Scotland as well? Will he look into this further?

Lord Callanan: I would be happy to have a further look at it and I completely agree with the noble Lord. I think the Scottish Government’s policy to rule out new nuclear is crazy, and what will end up happening is that Scotland will be supplied from nuclear power in England and Wales, because there are lots of interlinking connecters. The same thing is happening in Germany. Ironically, the Germans just announced that they were abandoning their nuclear stations, but will end being supplied by the huge number just across the border in France.

Lithium Ion Batteries:  Fire Safety Standards
 - Question

Lord Berkeley: To ask Her Majesty’s Government what fire safety standards are applied to lithium ion batteries in e-bikes, e-scooters and mobility scooters; and whether such batteries are safe to use and be charged in buildings.

Lord Callanan: My Lords, the product safety regulatory framework places obligations on manufacturers to ensure the safety of consumer goods, including the batteries used to power them. In short, the law requires that batteries used in such products must be inherently safe, regardless of where they are used, charged or stored. To support them, manufacturers may choose to apply standard EN 62133-2, which specifies requirements and safety tests for the safe operation of portable, sealed secondary lithium cells and batteries.

Lord Berkeley: My Lords, I thank the Minister for that Answer. I have a different EN number, which I will not bore the House with. He will be aware of a number of fires allegedly caused by lithium ion batteries in cars, on bikes and on scooters, which have caused house fires and one on an Underground train. One manufacturer told me that
“unless we can prove that a product has caused serious accident or injuries, there is no priority from Trading Standards to do any pro-active checks”.
Is not the answer to have proactive checks, as I believe they do in Belgium, the Netherlands and Germany, for about 10 years to prevent these illegal imports causing more fires, allowing the development of lithium ion batteries to continue safely?

Lord Callanan: The noble Lord highlights an important point. I am devastated that our EN numbers do not match, but I would be happy to compare them afterwards if the noble Lord wishes. It is vital that we carry out checks on illegally imported products; the fire that he referred to was caused by something not in conformity with UK standards. We carry out checks on a risk-based approach where required.

Baroness McIntosh of Pickering: My Lords, does the Minister not agree that if these e-scooters are privately owned, they are illegal, so they should not be taken on to the train in the first place?

Lord Callanan: No, I do not. If they are privately owned, there is a prohibition on riding them on public highways, but there is nothing wrong with taking them on trains if permitted by the train operators.

Baroness Randerson: My Lords, e-bikes and e-scooters are a great innovation, but it is the wild west out there. A lack of regulation and enforcement is giving them a bad reputation. There have been e-scooter trials and the assessments are now complete for many places, so there is no longer any excuse for government inaction. Will the Minister undertake to work with Department for Transport colleagues to commit to an early date for tighter restrictions on both imports and the way in which these vehicles are used on our roads and pavements?

Lord Callanan: I do not share the noble Baroness’s enthusiasm for banning e-scooters. The Department for Transport is considering options for how best to regulate them and to crack down on their illegal use, which we are all concerned about. New  measures being considered will be designed to create a much clearer, fit-for-purpose and fully enforceable regime for regulators.

Lord Bridges of Headley: My Lords, as we make the transition to net zero, we are going to need to rely on batteries more and more. Some 156 out of the world’s largest 211 battery factories are in China, which owns and controls enormous swathes of the supply chain. If we are going to get security of supply in batteries, what steps are the Government taking to ensure that that is going to happen?

Lord Callanan: The noble Lord makes an important point. The access to minerals and rare earth required to make batteries is a source of considerable interest to the Government. We are looking closely at where supplies can be obtained. He will be aware of the number of recent announcements on car batteries now being manufactured in gigafactories—or they will be—in the United Kingdom, but it is an important issue, and we need to bear it in mind.

Lord McNicol of West Kilbride: My Lords, when introduced and managed well, e-bikes and e-scooters can be part of the solution to many of the world’s urban transport and health issues. In fact, this morning I cycled in on my Scott e-bike, which got me here ahead of a lot of the other traffic. As my noble friend Lord Berkeley said, the solution is simple: better regulation and better enforcement. Do Her Majesty’s Government have any plans to introduce further enforcement and regulation which will help deliver good-quality batteries and good-quality bikes and scooters on our streets?

Lord Callanan: I am delighted to hear that the noble Lord came in today on his e-bike. I am unable to resist the opportunity to say that perhaps he could have a word with his friends in the trade unions, to allow us all to come in on the Tube if we would like to at the moment. As I said earlier, the Department for Transport is considering options for how best to regulate e-scooters and crack down on their illegal use.

Baroness Randerson: My Lords, as there is time in the schedule, can I invite the Minister to reconsider his reply to me? He accused me of calling for the banning of these vehicles, when I specifically praised their innovation. I asked for regulation, not annihilation.

Lord Callanan: If I heard the noble Baroness wrong, I apologise of course. We support responsible regulation. If that is what she supports us in doing, it is welcome news.

Lord Cormack: As one who does want annihilation, can I ask my noble friend to ensure that when these wretched machines, which go up to 40 mph, are on the roads, they are all properly registered and numbered, with their drivers fined if they are not wearing helmets?

Lord Callanan: I am not surprised that the noble Lord supports annihilation. I do not agree with him. E-scooters represent great opportunities for urban mobility. Yes, we need to regulate them properly, ensure that they are used safely and of course ensure that riders are safe, but they offer a responsible commuting option for many people.

Bishop of Leeds: My Lords, however these things are regulated, we are building up a massive resource of batteries that one day will have to be disposed of, with the environmental risks that they bring as well. What assessment have the Government made of how in the long term we will deal with what could before too long become a problem?

Lord Callanan: The right reverend Prelate makes an important point but, of course, better than disposing of the batteries would be to recycle them. A number of technologies exist to enable batteries to be reused, recycled and repurposed. There are a number of instances of electric car batteries being reused as portable electricity storage devices in the home.

Lord Hain: My Lords, what incentives are the Government offering to householders with solar PV panels to install batteries so that they can become more self-sufficient in their electricity generation, including charging their electric cars where that is possible?

Lord Callanan: It is an important point. We offer an attractive tariff for consumers who generate their own electricity to export to the grid but, as that tariff is lower than that for which they would have to buy the electricity themselves, there is an incentive, if possible, to store it and reuse it. As we get more EVs, we will see their increasing use as storage devices, and companies will start to offer an attractive tariff to enable electricity to be released from those at times of busy demand.

Baroness Walmsley: My Lords, going back to the right reverend Prelate’s question, how many facilities for recycling batteries are there in the UK, and what is being done to make sure that we have end-to-end design technologies in this country?

Lord Callanan: I do not have figures for the precise number of battery recycling plants in the UK. I am aware of some developments in that field, but I do not have the precise numbers. The noble Baroness makes an important point: that we need to ensure end-to-end recycling and reuse.

Lord Berkeley: My Lords, I am grateful to the Minister for his earlier response to me, but he will be aware that in the last month two train companies have banned electric bikes and scooters being taken on to their trains. That has now been withdrawn, but it was done because London Fire Brigade’s press release was a bit unclear about the risk. This goes back to the lack of a firm specification for and firm enforcement of the quality of batteries so that there is no misunderstanding. It has upset a lot of people.

Lord Callanan: I think that there was one incident on one Transport for London train, which was caused by an illegal product—it was not even properly regulated. In what I thought was a gross overreaction, Transport for London then banned e-scooters, but other train operators allow them. It is obviously a matter for individual companies to work out the risks, but a relatively tiny number of incidents have been caused from the more than 1 million that we estimate are currently in use.

International Women’s Day
 - Question

Baroness Anelay of St Johns: To ask Her Majesty’s Government how they plan to mark International Women’s Day on 8 March.

Baroness Stedman-Scott: This year’s International Women’s Day global theme is “Break the Bias”, which encourages everyone to call out bias, smash stereotypes, break inequality and reject discrimination. The UK Government will showcase our leadership in supporting women and girls in the UK and around the world. Our key moment will be the launch of a new programme to support adolescent girls overseas with 21st-century skills to give them the knowledge and qualifications they need for employment and enterprise. The Government will also make an announcement on focusing on improving the workplace for women.

Baroness Anelay of St Johns: My Lords, in welcoming the way forward that my noble friend the Minister has laid out, I ask her to consider the importance of breaking the bias in places such as Afghanistan, where up to 12 million women and girls currently face the risk of severe malnutrition, particularly lactating mothers. For example, 100% of the households headed by women simply choose not to eat to make sure their children can. Can my noble friend update the House on what we are doing through our overseas aid to ensure that humanitarian relief reaches them and not the male members of the Taliban?

Baroness Stedman-Scott: The UK’s aid of £286 million for 2021-22 provides live-saving support to the most vulnerable. The UK is pressing the World Bank and its shareholders to allocate the remainder of the £1.2 billion that is in the Afghan reconstruction trust fund. This includes the release of £280 million in December, which helped to ensure that health services are accessible and available for women and girls and supported households to access food.

Baroness Northover: My Lords, does the Minister agree that a good start for International Women’s Day would be for the United Kingdom to be as open as the EU to women and girls fleeing extreme violence in Ukraine?

Baroness Stedman-Scott: I am sure that all of us support the point that the noble Baroness makes. I am sure that our Government are in dialogue with the EU to ensure that we fulfil all our obligations to help young girls in this terrible situation.

Baroness Gale: Is the Minister aware—I am sure that she is—that there will be nothing on 8 March to mark International Women’s Day in your Lordships’ House, which goes against all our traditions over many years? Can she explain why the debate marking it will be held in Grand Committee nine days later on 17 March, by which time I think it will have become a little irrelevant? Can she ensure that this never happens again and that we have the debate in this Chamber? Could we also have Oral Questions relating to women on International Women’s Day, which again has been done for many years but which, because of the luck of the draw now that we have ballots, has become even more difficult? Would she be willing to work with me to work out a system whereby we can ensure that we have Questions relating to women in the Chamber on International Women’s Day?

Baroness Stedman-Scott: I will try to answer the noble Baroness’s questions. On the debate being on 17 March, I am sure—and I refer to my noble friend the Leader—that it is to do with parliamentary timetabling. I know that the noble Baroness and others are disappointed and I am even more sorry that the ballot has not gone the way that the noble Baroness wanted it to. In relation to 17 March, I am going to the United Nations on 14 March to attend the Commission on the Status of Women and the noble Baroness will be pleased to know that when I get off the aeroplane at 6.30 am on Thursday I will be heading straight back to the Chamber to share what has happened with everybody. I will make sure that I have further dialogue with the noble Baroness; I cannot promise for this never to happen again but let us talk.

Lord Alton of Liverpool: My Lords, the Minister will be aware from the debate in your Lordships’ House last night that there are still thousands of Yazidi women and girls who have been abducted, many of them having been raped in the process. She will know that a letter was delivered to Downing Street last September. That still awaits a reply. To mark International Women’s Day, will she ensure that the Government respond and say what they are doing to ensure that those still many missing girls will be brought to freedom and those responsible for the crimes will be brought to justice?

Baroness Stedman-Scott: The situation that the noble Lord describes is truly shocking. I can confirm that the UK advocated strongly for the passage through Parliament of the Yazidi survivors’ law, which formally recognises the terrible crimes that the Daesh community has committed against humanity. We have established a general directorate for Yazidi survivors’ affairs, which is responsible for searching for survivors who are still missing and for co-ordinating with judicial and investigative bodies. I will try to find out when the noble Lord is going to get a reply to that letter and will get straight back to him.

Baroness Boycott: My Lords, 50 years ago, when we founded Spare Rib and the first women’s refuge was set up in Chiswick High Street by Erin Pizzey, 1.6 women a week were killed by their partner or previous partner in England and Wales; the figure today is two a week. Can anyone imagine 104 women all on Parliament Square all being killed at the same time? This is a huge crime that goes largely unremarked on. What are the Government doing this year to support these women, to change some of the culture in the police and to take domestic violence more seriously? Let us not be looking at higher figure in 50 years’ time.

Baroness Stedman-Scott: Domestic violence is a subject that is near to everybody’s heart and we are doing all we can to support people to ensure that we do not have the situation described by the noble Baroness. I cannot answer for what the police are doing but I will go back to my noble friend Lady Williams and ask her to reply directly to the noble Baroness’s question.

Baroness Symons of Vernham Dean: My Lords, I voice my concerns, as my noble friend has done, that this House is not celebrating International Women’s Day on International Women’s Day. It seems quite extraordinary. Can the Minister address the continuing ghastly practice of female genital mutilation, which is still very widely practised around the world? Can she say what active steps are being taken by Her Majesty’s Government to deal with that? There are two points: one, it seems extraordinary that a parliamentary session should not celebrate such an important day and, two, what are we doing about FGM?

Baroness Stedman-Scott: The message has been received from both noble Baronesses about celebrating on the day. As I say, I believe it is about parliamentary timetabling. I am sorry, I can tell the noble Baroness only what I understand but I will come back to her and confirm that. FGM is a detestable activity and the Government significantly strengthened the law on it in 2015. We introduced a new offence of failing to protect girls, extended the reach of extraterritorial offences and introduced life-long immunity for victims of FGM. Ministry of Justice data shows that almost 700 FGM protection orders have been issued since their introduction.

Baroness Fookes: My Lords, are the Government sufficiently aware of the problems faced by women already living in this country who do not speak English—and the many who will come in as refugees in a similar position—which handicaps all of them in terms of their rights and their career opportunities? Are the Government doing anything practical to help this situation?

Baroness Stedman-Scott: I am very pleased to say that we recognise that the ability to speak English is key to helping refugees integrate into life in England. It is absolutely fundamental to them being able to work and to have a productive life. That is why the Home Office is working closely with other departments to ensure that mainstream English language provision  meets the needs of refugees. The Home Office provides £850 for each individual resettled in the country to help them develop their English.

Baroness Wilcox of Newport: My Lords, the Association of British Insurers has reported that on this International Women’s Day there remain key areas where action can and should be taken to ensure gender parity in the world of work by reducing gender pay and seniority gaps, and in society by addressing gender pensions gaps and inequality. Can the Minister tell us how the Government, through their policies and legislation, intend to plug these serious gaps for women in work and in our wider society?

Baroness Stedman-Scott: The noble Baroness raises a really important point. I point out that the gender pay gap has fallen significantly under this Government, there are 1.9 million more women in work since 2010, and a higher percentage of women are on FTSE 350 company boards than ever before. In my role as Minister for Women I have been working with the Women’s Business Council—this issue is very important to it—and the Alison Rose review. I would be very happy to have a meeting with the noble Baroness and share more details.

Russia: Sanctions
 - Question

Lord Dodds of Duncairn: To ask Her Majesty’s Government what assessment they have made of the likely impact of the sanctions they have introduced against Russia since the invasion of Ukraine.

Lord Ahmad of Wimbledon: My Lords, the impact of our and the allied sanctions is significant. At least $250 billion has been wiped off the Russian stock market since the invasion and the rouble has reached record lows against the dollar and sterling. The central bank of Russia has taken unprecedented measures to prop up the rouble, preventing capital flight, and has raised interest rates to 20% from 9.5%. We have also restricted access to high-end technology, blunting the Russian economy for years to come. We continue to ratchet up pressure in conjunction with our allies.

Lord Dodds of Duncairn: My Lords, the courage of the Ukrainian people continues to inspire us all, but it also compels us to ask what more can be done. There is no doubt that the sanctions that have been introduced by this country and across the world have been far more far-reaching in their application and scope—and indeed the speed of their introduction—than the Kremlin could possibly have imagined. We have seen major changes in some Governments’ approach to defence issues, for instance; I think of Germany. Is the Minister concerned about those countries which are not stepping up to the mark? I think of the Commonwealth countries such as India, the most populous democracy in the world. What is being done  to try to persuade it to join the international consensus? There is also, of course, China. What can be done to persuade it to do more behind the scenes to be an influence for good in this terrible situation?

Lord Ahmad of Wimbledon: I agree with the noble Lord. There has been unprecedented action to work with our allies in applying sanctions. This underlines the effectiveness of the sanctions: we are able to work together with those countries or jurisdictions, such as the EU, which also have sanctions policies. The noble Lord raises a valid point about what more can be done. We will be debating the laying of further sanctions later today. Further sanctions on Belarus have also been announced—there will be legislation in that respect.
On the specific question of the Commonwealth, I am engaging directly with key partners. We secured a great deal of support from Commonwealth partners at the UN General Assembly vote. Yesterday, we saw 141 nations of the UN General Assembly vote in favour of the Ukraine resolution. That is no small feat.
I will turn to the important issues of China and India. China abstained and did not veto the resolution twice over. India obviously has a long-established relationship with Russia. However, I assure noble Lords that we are working very closely with our Indian partners to also encourage them to reflect on the current situation. As we have seen, they are also extremely challenged by the exodus of Indian students from Ukraine. I assure the noble Lord that we are working very closely with India, and other partners, in this respect.

Lord Collins of Highbury: My Lords, the Minister used the term “ratchet up”. No doubt, he would have heard a solicitor on the radio this morning talking about the potential risk of asset flight. He said that he was advising his clients, if they had not been sanctioned, to get their money out now. What is the Minister’s response to that? I heard the Minister on the radio say that it was all part of a programme, but speed is of the absolute essence here. We need faster action and, possibly, emergency powers.

Lord Ahmad of Wimbledon: The Government have been responding, and expediting legislation. In this regard, as I have said before, I am grateful to the usual channels for accommodating these requests. Looking through my own commitments and those of the noble Lord, in the coming days, we will be speaking quite specifically on the legislation being laid.
I agree that the issue of asset flight is an important consideration. This is why we are reluctant to make announcements in advance, particularly those regarding individuals and organisations. As we know, there are individuals who are taking actions based on what has already happened. Equally, we need to ensure that every sanction imposed is legally robust and tested. This is an important part of our sanctions policy and those of international partners. There are those who may respond to our sanctions by sanctioning individuals, because their legal framework is not as strong ours. It  is important that any sanction we impose—be it on an individual or an organisation—is fully tested and robust in its application.

Lord Purvis of Tweed: My Lords, the strongest possible sanctions are fully justified. However, we must be mindful that there are other victims of this conflict in developing countries where wheat prices have already gone up, and energy and fuel prices are going up. This will create a secondary humanitarian impact. The Government’s humanitarian support for Ukraine is extremely welcome: £140 million in ODA and $500 million of drawing rights from the multilateral development banks. However, the Government have capped our aid at 0.5%, and have cut their support for the IDA by 55% this year. Will the Minister reassure me and the House that our support for developing countries will not be affected by this additional support, which is very welcome for Ukraine?

Lord Ahmad of Wimbledon: I assure the noble Lord that we are working to ensure that we respond effectively to Ukraine. I know that the noble Lord has been very supportive of the package we announced in support of humanitarian assistance. Equally, we are very conscious of our obligations in other parts of the world. Your Lordships’ House has been through challenging circumstances on Afghanistan. We know about the continuing conflicts in places such as Yemen, and the issue with the Rohingya crisis in Myanmar and Bangladesh. I assure the noble Lord that we are very much focused on ensuring that our response to these issues is equally robust.

Lord Craig of Radley: My Lords, in addition to economic sanctions, what scope is there now for more diplomatic sanctions during this terrible situation? For example, after the Salisbury event, considerable diplomatic sanctions were imposed.

Lord Ahmad of Wimbledon: I am sure that the noble and gallant Lord will appreciate that I will not go into specifics on what steps we are taking next. I assure the noble and gallant Lord, as my right honour friend the Foreign Secretary has said, that all options are very much on the table on how we can further pressure Russia to do the right thing. If it pulls back from Ukraine, talks can begin. All credit goes to the Ukrainians who are engaging in this initiative on the Belarus border. At the same time, Russia is, as I said yesterday, holding a trigger to the head of the Ukrainians and claiming that they believe diplomacy to be the route forward.

Lord Bridges of Headley: My Lords, first, I applaud my noble friend for all he is doing. Given that the aim of the Government is to stop the financing of President Putin’s war machine—and given that he has just said that nothing is off the table—can the Minister confirm that the Government have not ruled out calling for the complete cessation of all European imports of Russian oil and gas, and of all payments for Russian oil and gas under existing long-term contracts? Can the Minister also confirm that the Government have not ruled out banning Gazprombank and Sberbank from SWIFT?

Lord Ahmad of Wimbledon: My noble friend raises some quite specific points. On his final point about SWIFT and a number of banks, they have already been directly impacted by some of the steps we have taken. The noble Lord will be aware of the position of Her Majesty’s Government with our key partners on the total suspension of access to SWIFT.
He also raises a number of other points. As I said in response to a previous question, I will not at this time—not least for some of the points which the noble Lord, Lord Collins, raised—be explicit on what kinds of designations or steps we may take against specific institutions or individuals. But the actions of the Government are clear, and I am sure that people are watching the situation very closely.

Lord Foulkes of Cumnock: My Lords, the Government have taken significant action in relation to sanctions. The Minister, personally, has been significantly helpful in relation to this. However, there is one further sanction which has not yet been considered and which I ask him and his colleagues in the Home Office to consider: using the powers that we have to remove British citizenship from Putin’s oligarchs living in the United Kingdom.

Lord Ahmad of Wimbledon: I am sure the Home Office has heard the point which the noble Lord has made quite clearly. This is evident in the steps taken recently by my right honourable friend the Home Secretary in support of Ukraine, and her response to many of the points raised in your Lordships’ House. As I said, we are looking at the full picture. I stress the point that there are many Russians in the United Kingdom who are dual nationals. There are many Russians who do not have British citizenship but are residing in the UK. There are many Russians in Russia, as we saw in St Petersburg, who are totally and utterly against Mr Putin and his Government. It is important that we stand by them as well.

Baroness Butler-Sloss: My Lords, I ask the Minister why there are no applications to the court for freezing orders.

Lord Ahmad of Wimbledon: As I have said, and as the noble and learned Baroness will know, all the actions we are taking, including the sanctions policy, are based on a legal framework to ensure that first sanctions can be applied. Equally, there needs to be a legal recourse for those people who feel that a sanction has been applied against them which is not justified. I assure the noble and learned Baroness that the legal framework is very much incorporated into our sanctions framework.
I will make a slightly further point: she would have seen that we are now working with the International Criminal Court, specifically on crimes that are committed within Ukraine. This is a point which noble Lords, in particular, the noble Lord, Lord Alton, have raised with me. We are moving forward in that respect as well.

Business of the House
 - Motion to Agree

Baroness Evans of Bowes Park: Moved by Baroness Evans of Bowes Park
That Standing Order 73 (Affirmative Instruments) be dispensed with on Thursday 3 March to enable motions to approve the Russia (Sanctions) (EU Exit) (Amendment) (No. 2) Regulations 2022 and Russia (Sanctions) (EU Exit) (Amendment) (No. 3) Regulations 2022 to be moved, notwithstanding that no report from the Joint Committee on Statutory Instruments on the instruments has been laid before the House.
Motion agreed.

Highgate Cemetery Bill [HL]
 - Commons Amendments

Motion on Amendments 1 to 4

The Senior Deputy Speaker: Moved by The Senior Deputy Speaker
That the House do agree with the Commons in their Amendments 1 to 4.
1: Clause 4, page 4, line 6, after “may,” insert “by notice given”
2: Page 4, leave out line 23 and insert—“(i) on the burial authority’s website; or”
3: Page 4, line 24, leave out “otherwise,”
4: Page 5, line 1, leave out “(12)” and insert “(11), (13) and (14)”
Motion agreed.

Motion on Amendments 5 and 5A

The Senior Deputy Speaker: Moved by The Senior Deputy Speaker
That this House do agree with the Commons in their Amendment 5, and do propose Amendment 5A as an amendment thereto—
5A: Paragraph (a), at end insert—“(aa) where notice of objection is given under subsection (9) and the objection is withdrawn, on the date specified under subsection (6)(b) or the day after the objection is withdrawn, whichever is later, or”

Lord Aberdare: I was glad to serve on your Lordships’ Opposed Private Bill Committee on this Bill last year, the first time that such a committee has been conducted entirely remotely, under the brilliant chairmanship of my noble and learned friend Lady Hallett. It is good to see that the Bill is now nearing the end of its passage through Parliament, and the Commons amendments make a great deal of sense, as does the Senior Deputy Speaker’s Motion, which I fully support.
Motion agreed.

Motion on Amendments 6 to 10

The Senior Deputy Speaker: Moved by The Senior Deputy Speaker
That the House do agree with the Commons in their Amendments 6 to 10.
6: Page 5, line 20, at end insert—“(10A) The burial authority must publish on its website or by other appropriate means, and make available on request, a policy setting out how it will exercise its powers under this section in relation to memorials.”
7: Clause 5, page 6, leave out line 15 and insert—“(i) on the burial authority’s website; or”
8: Page 6, line 16, leave out “otherwise,”
9: Page 7, line 22, at end insert—“(12A) The burial authority must publish on its website or by other appropriate means, and make available on request, a policy setting out how it will exercise its powers under this section in relation to memorials.”
10: Clause 6, page 8, line 7, at end insert—“(3A) The burial authority may from time to time, following consultation with the Historic Buildings and Monuments Commission for England and the London Borough of Camden, revoke the designation of any grave as a protected grave.”
Motion agreed.

Health and Care Bill
 - Report (2nd Day)

Relevant documents: 15th, 16th and 19th Reports from the Delegated Powers Committee, 9th Report from the Constitution Committee

  
Clause 20: General functions

Amendment 36

Lord Kamall: Moved by Lord Kamall
36: Clause 20, page 21, line 25, at end insert—“(ba) set out any steps that the integrated care board proposes to take to address the particular needs of children and young persons under the age of 25;”Member’s explanatory statementThis amendment requires the joint forward plan for an integrated care board and its partners to set out any steps that the integrated care board proposes to take to address the particular needs of children or young persons under the age of 25.

Lord Kamall: My Lords, I thank the House for its continued focus on addressing the needs of babies, children and young people and thank noble Lords for bringing forward amendments on this issue again today. I am also really grateful to noble Lords who have engaged with the me and my officials, and I hope that this has resulted in amendments that your Lordships’ House feels that it can support.
I start with Amendment 36, in my name. This amendment will require an integrated care board to set out any steps that it proposes to take to address the particular needs of children and young people under the age of 25 in the forward plan. In addition, the Government have committed to produce a package of  bespoke guidance, which explains how the ICB and the ICP should meet the needs of babies, children, young people and families. This guidance will contain provisions for the integrated care partnership’s integrated care strategy to consider child health and well-being outcomes and the integration of children’s services, as well as providing that the integrated care partnership should consult local children’s leadership and children, young people and families themselves, on the strategy.
NHS England has also agreed that it will issue statutory guidance, expecting that one of the ICB executive leads will act as a children’s lead, with responsibility for championing the needs of babies, children and young people. I hope that noble Lords are supportive of this government amendment and its underpinning commitment to support, improve and enhance services for babies, children and young people.
I turn to Amendments 157, 185 and 186. Safeguarding children is a priority for the Government, and we share the horror and concern provoked by the awful murders of Arthur Labinjo-Hughes and Star Hobson. The Government are committed to addressing barriers to safe, timely and appropriate sharing of information to safeguard children, and we have heard clearly the strength of feeling across the House on the value of a consistent identifier for children. In particular, I pay tribute to the noble Baroness, Lady Tyler of Enfield, and other noble Lords, for pushing us on this issue.
To this end, we are committing in this legislation to publish a report, within one year of the section coming into force, that will describe the Government’s policy on information sharing in relation to children’s health and social care and the safeguarding of children and will include an explanation of the Government’s policy on a consistent identifier for children. It will also include the Government’s approach and actions to implement the policy set out in the report. The Government agree with noble Lords that action is needed. The report will reflect a cross-government position on what actions will be taken to improve safe and appropriate information sharing.
This amendment, of necessity, is limited by reference to health and social care, reflecting the scope of the Bill. However, the report to which this amendment refers will be laid by the Secretary of State for Education, who intends that it will cover improved information sharing between all safeguarding partners, including the NHS, local authorities and the police, as well as education settings. The Department for Education has already started its work, which will look at the feasibility of a common child identifier. I hope these amendments will reassure noble Lords that the Government are committed to safeguarding children and improving services for babies, children and young people. I beg to move.

Baroness Hollins: My Lords, I am grateful to the Royal College of Speech and Language Therapists, the National Children’s Bureau, the Disabled Children’s Partnership and the Royal College of Paediatrics and Child Health for their support with this amendment and for their constructive engagement with the Department of Health and Social Care. I also thank the noble Baroness, Lady Tyler, for adding her name to this amendment.
I welcome the amendments that the Minister has laid relating to the needs of babies, children and young people but, despite the good progress made, this amendment seeks to go further by requiring NHS England to conduct a performance assessment of each ICB in meeting the needs of babies, children and young people in each financial year. This includes its duties concerning the improvement in quality of services and reducing inequalities and the extent of its public involvement and consultation.
There are significant challenges in meeting the health and care needs of children and young people, including their mental health needs, which are different and arguably more complex than for adults. This is particularly the case for disabled children and young people and those with special educational needs. A recent survey by the Disabled Children’s Partnership and the parent campaign group, Let Us Learn Too, found that 40% of families with disabled children have seen their savings wiped out by fighting and paying for support.
I shall give one brief example from the West Midlands. Joanne, whose autistic son also has pathological demand avoidance and communication difficulties, explained that the local authority refused to do an occupational therapy assessment, so she paid for one privately. Eventually, she took the local authority to tribunal at considerable expense in legal fees. Despite winning, it is one year on and still no support is being provided by the local authority.
One in three families with disabled children said they needed publicly unprovided essential therapies for their disabled child, but could not afford them. Some 60% of families with disabled children have sought NHS mental health support for a family member due to the stress of fighting for basic services. The Disabled Children’s Partnership cites individuals feeling a sense of societal resentment toward disabled people, says that carers are persistently undervalued and underrepresented in policy and details the enormous physical, emotional and financial burden they endure in caring for their disabled family member without adequate support from the health and care sectors. Joanne said, furthermore, that the local authority blamed her for her son’s disability and put a child protection plan in place rather than supporting her, although thankfully it was removed shortly afterwards.
Integrated care boards have a crucial role in commissioning primary and community healthcare services directly for babies, children and young people. They will play a key role in the joint commissioning of services for disabled children and those with special educational needs, as well as contributing to education, health and care plans and in the commissioning of joined-up services in the first 1,000 days of life, in which the Government are, importantly, investing. Crucially, ICBs will be jointly responsible for the leadership of local child safeguarding partnerships, together with the police and local authorities.
Yet support for children and young people varies geographically. Local systems find themselves pulled in different directions by different government initiatives and separate pots of funding, which creates a profound risk of destabilising what are relatively new local safeguarding partnerships. The Wood report, published in May 2021, reviewed the new multi-agency safeguarding  arrangements put in place by the Children and Social Work Act 2017. It revealed just how stretched the resources are in protecting children, as well as the need for a more effective culture of joined-up working and a more consistent and detailed understanding of the role of the three statutory safeguarding partners—the local authority, the CCG and the chief officer of police. The Wood report also emphasised the importance of accountability regarding the quality of these services and the need for inspectorates and regulators to develop a model to analyse performance against what is deemed to be best practice, something that this amendment goes a long way to trying to achieve.
Perhaps more worryingly, an assessment conducted by NHS England in December found that only three ICBs were considered ready to take on their safeguarding responsibilities, with a remaining 39 still in progress or in need of support. That highlights how important it is that ICBs are both supported and held to account with regard to these duties.
I recognise that the aim of the Bill is not to overprescribe what local systems do, and I agree that ICBs must be free to respond to local need. But to deliver the best outcomes for children, there must be a clear vision for children’s health and welfare that is shared at national and local levels and with the necessary accountability for delivering it. I hope that the Government can provide assurances to your Lordships’ House that all children and young people, including disabled youngsters, will be properly reflected in the NHSE performance assessment frameworks currently being developed, that the role of ICBs in meeting their needs will be an ongoing focus of NHS England and Her Majesty’s Government, and that all ICBs will be supported to be ready to take on their safeguarding responsibilities from July this year.
The proposed amendment would help to deliver on the recommendations of the Wood report by ensuring important multiagency working and accountability for the welfare of babies, children and young people. I urge the Minister to accept the amendment.

Baroness Tyler of Enfield: I support and very much welcome government Amendments 36, 157 and 185 in response to the powerful debates in Committee on children’s health, safeguarding, data-sharing and particularly the case for a unique identifier for children, on which I put forward an amendment in Committee. I thank the Minister for engaging so fully and positively on these issues and for the various meetings which led to these amendments being tabled. It is also very welcome that Amendment 36 includes children in the Bill, which so many of us have argued for.
On the unique identifier as a means of identifying children in touch with multiple services, aiding safeguarding and promoting joined-up support, I strongly support the government amendment to lay a report before Parliament on information sharing and on a single unique identifier for children. That is a real step forward, and it is clear that the Government acknowledge that there are serious and distinct challenges with sharing relevant information across not just children and social care sectors but others too, including schools and the police.
There is always more to do, so I will never be 100% satisfied and I note that the amendment as tabled does not actually commit the Government to any specific timed action beyond publishing the report. Therefore, it was good to hear the further assurances that the noble Lord, Lord Kamall, gave at the Dispatch Box. I think I heard him say clearly and unequivocally that the Government are committed to developing plans not just to look at the case for but to adopt a single unique identifier for children. I think I also heard a commitment to developing a set of cross-government proposals for implementing that, and then, I hope, acting on the findings of this report within a defined timescale. If the Minister could reiterate those commitments, I would be extremely grateful. I would also welcome a commitment to involving those organisations representing children and young people, who have been so much a part of our discussions and debates, as part of the production of that Bill.
I support Amendment 59 from the noble Baroness, Lady Hollins, which I signed, requiring NHS England to assess annually how well each ICB is doing in meeting the needs of children and young people; it provides much-needed accountability and transparency, particularly in relation to the new and crucial safeguarding responsibilities that ICBs are taking on. I welcome the statutory guidance, which I know the Government intend to produce, on having a children’s lead on the board of every ICB. That is really important.
I support the suite of amendments in the name of the noble Lord, Lord Farmer. I will leave him to set out the case for them, but I agree that family hubs play a really important role in improving early intervention services, helping integration and data sharing among public services and involving the voluntary sector. Importantly, and germane to this Bill, that includes children’s health services, which are often better delivered in community settings with other family support services. I particularly support Amendment 75, which calls for each local authority to provide a family hub. That is central to a national rollout of family hubs. which I would like to see at the very core of a national strategy on child vulnerability.

Lord Farmer: I start by thanking the noble Baroness, Lady Tyler, for her support; it is very much appreciated. She has been a doughty warrior accompanying us along this path for many years.
I will speak to my Amendments 64, 66, 68 and 75 and I thank the Minister for the meetings I have had with him and the Bill team to hear his concerns, particularly around being overprescriptive.
Amendment 64 simply replaces “may” with “must” and thereby requires integrated care partnership strategies to lay out how health-related services can be more closely integrated with health and social care. In Committee, I said that “may” made that aspect of integration voluntaristic, and I would be grateful if the Minister could explain why, as I am genuinely mystified, the ICP is at present only invited to do that.
Amendment 66 has been revised after the discussions mentioned earlier. I propose adding new subsection (5A) to Clause 116ZB to specifically invite ICPs to consider  how family help services, including those accessed through family hubs, could be more closely integrated with arrangements for the provision of health services and social care services in that area. I avoid using “must” in that case, because it could place an overly prescriptive requirement on ICPs. I also avoid mandating the use of family hubs. They are simply mentioned as an important potential access point.
I recognise and applaud the many ways that the Government have improved the Bill with respect to children’s health. However, I explained in Committee that many children’s health needs are psychosocial: they need practical, not just medical, solutions and addressing them needs a whole-family approach. That is also particularly important when parents experience drug and alcohol problems, which can affect their children almost or as much as the parents themselves.
Early family help commissioned by local authorities therefore needs to be integrated with health as well as many other departments of government. Family hubs are mentioned in my amendment, not prescriptively but as the model that could enable that to happen. In Committee, I described how DWP’s Reducing Parental Conflict programme, DLUHC’s Supporting Families and the MOJ’s private family law pilots all looked to family hubs as an access point for those who need this support. The Bill could and should help to make that model proliferate to benefit families. As it operates according to principles, not an overly prescribed framework, it can be tailored to local need, including by drawing in the bespoke work of the local voluntary and community sector. Historically and currently, health services have had a poor track record in integrating with local government and wider partners. The Children’s Centre movement frequently lamented the lack of engagement with health. The opportunity the Bill provides to avoid that pattern being repeated should not be missed.
My Amendment 66 gives meaning to the phrase “family help” and points towards an amended Schedule 2 to the Children Act 1989 to explain what is meant by “family hubs”. In Committee, I explained that
“services which improve children’s lives through supporting the family unit and strengthening family relationships to enable children to thrive and keep families together”
is the independent care review’s working definition of “family help”. This is not a concept to be set in concrete in the lead reviewer’s final report, but simply one that is qualitatively different from “family support” in local authority usage. The latter leans towards late-stage statutory child protection, which ideally prevents children entering care and is far from the early help so many parents need.
Finally, my Amendment 75 necessarily changes how the Children Act 1989 refers to family help infrastructure to reflect more closely the way it has developed. It has also been adjusted since Committee to avoid mandating local authorities to provide family hubs, which would have significant cost implications, ultimately for the Treasury. As a result of my amendment, new Schedule 2(9) to the Children Act would state:
“Every local authority shall provide such family hubs as they consider appropriate with regard to local needs in relation to children and families within their area.”
“Family hubs” means an access point where children, their parents, relatives and carers can access advice, guidance, counselling or paediatric health services as well as occupational, social, cultural or recreational activities. This removes the anachronistic reference to and description of “family centres”. These were never consistently implemented in the way probably envisaged by the draftsmen of the 1989 Act, although children’s centres did emerge to fulfil many of their purposes in response to research on the importance of children’s early years.
To address the Minister’s concerns that putting family hubs into legislation would introduce unhelpful rigidity and prescription, I end by making an analogy with the Supporting Families programme. This does have a legislative underpinning, but the early troubled families programme from which it evolved provided principles for a tried, tested and consistent way of working, illustrated these with case studies and supported local authorities to develop their own bespoke approaches to that way of working. The DfE is taking a similar non-prescriptive approach in its family hubs framework, which emphasises principles—namely, access, connection and relationships—and avoids determining how local authorities implement these. Just as the Supporting Families programme has developed but is still recognisably the same way of working launched as “troubled families” 10 years ago, I and others anticipate the same continuous improvement trajectory for the family hubs model or way of working.
Family hubs are now official government policy, backed by a £130 million commitment, a major evaluation programme and decades of supportive research. The model is not prescriptive but enabling and supported by many local authorities and those designing health systems. I would be grateful, in conclusion, if the Minister would explain, after these assurances, why this important social infrastructure, the fruit of 30 years of reform, which builds on and extends Labour’s legacy of Sure Start centres, has no place in the Bill.

Baroness Walmsley: My Lords, I congratulate the noble Lord, Lord Farmer, on his efforts to keep the issue of prevention and early intervention before us: it is vital. I also thank the Minister for the government amendments and the way he has engaged with us over this issue. I was particularly pleased to hear him use the word “action” at least two or three times in his introduction to the amendments. I congratulate the noble Baroness, Lady Hollins, and my noble friend Lady Tyler, on all they have done but in particular for pointing out, in their Amendment 59, that there could be a bit of a gap here. We have the CQC, which will inspect individual healthcare settings and, under the Bill, it will also have to see how the new integrated care system is working, but there is no guarantee that it will see it as part of its duty to see how that system is working for children. This is something that the NHS could do through the report called for in Amendment 59.

Lord Shinkwin: My Lords, I too thank my noble friend the Minister for Amendments 36 and 157. I shall also speak in support of Amendment 59 in the name of the noble Baroness, Lady Hollins. Before I do  so, I hope your Lordships’ House will allow me to take this opportunity to thank the healthcare professionals at Guy’s and St Thomas’s, who recently looked after me so well following major surgery. Some noble Lords may have noticed my absence. I have had half my leg rebuilt and am now the proud, if involuntary, owner of a Meccano set inserted by my excellent surgeon, Marcus Bankes, and his registrar, Christian Smith. I apologise in advance if any noble Lord seeks to intervene and I dare not sit down to take their intervention as I am not sure I would be able to get back up again.
Although the pain was excruciating and the morphine, which I am weaning myself off, very welcome, it saddens me to say that that pain was compounded by the way in which I received no support from your Lordships’ House. I might as well have been dead. It reminded me that this wonderful institution remains a place whose rules and modus operandi were designed by and for rich, non-disabled men. I will say no more on the matter now, but it is clear to me that this needs to change if we are to become a stronger, more diverse, more representative House. If we do not want to be consigned to the past, we must stop living in the past. The appalling way we treat Members whose disability enforces temporary absence from your Lordships’ House is indefensible and cannot continue.
Returning to the substance of the amendments under discussion, I am hugely grateful that the Government have listened to concerns I raised at Second Reading and others raised, in my absence, in Committee. All credit goes to noble Lords for the strength and the passion with which they did this, and to the Minister for so obviously listening and taking their concerns on board. Taken together, Amendments 36 and 157 should make a real difference to the lives of all babies, children and young people in this country, particularly those with speech, language and communication needs. I should declare at this point my interest as a vice-president of the Royal College of Speech and Language Therapists. I know the Minister and his colleagues across government, not just in the Department of Health and Social Care but also in the Department for Education and the Ministry of Justice, share my ambition and the ambition of other noble Lords in wanting children and young people with communication needs and their families to have the best possible level of support so they can realise their potential.
To help deliver that ambition, I ask my noble friend to reflect on four things. First, I would be so grateful if he would look kindly on Amendment 59, so ably spoken to by the noble Baroness, Lady Hollins. This would help to close any potential accountability gap and considerably strengthen the provisions of Amendment 36.
Secondly, will the Minister pledge to ensure that all the guidance to the Bill specifically references children’s speech, language and communication needs? The statutory guidance and accountability lead for SEND is a very positive development, but it is not sufficient. The vast majority of children with communication needs do not have an education, health and care plan. This includes children with developmental language disorder—over 7% of all children—those who stammer, and  those with speech-sound disorders. The guidance must, therefore, ensure that the needs of those children are supported. A model that the Government have already established for this is the statutory guidance to the Domestic Abuse Act, where speech, language and communication are listed as a specific intersectionality.
Thirdly, will the Minister agree to meet the chief executive of the Royal College of Speech and Language Therapists to discuss how the guidance on the Bill can best capture those issues? Fourthly, on Amendment 157, can the Minister reassure the House that the report will include commitments to act to improve information-sharing? Finally, may I reiterate my huge thanks to my noble friend the Minister, and say how pleased I am to be able to do so in person, in your Lordships’ House? It is good to be back.

Baroness McIntosh of Pickering: My Lords, I welcome my noble friend back and commend him for his bravery. We came into the House at the same time, and he is a source of constant inspiration to us all; I have endless admiration for him. I apologise to the House for having omitted to declare my interests when I spoke for the first time on Report on Tuesday. I refer to my entry in the register of interests, and in particular to the fact that I work with the board of the Dispensing Doctors’ Association. I am also a patron of the National Association of Child Contact Centres and a co-chair of the All-Party Group on Child Contact Centres and Services.
I again commend my noble friend the Minister for summing up and assessing the mood of the House and tabling the amendments today; I am grateful to him for that. I also support the noble Baroness, Lady Hollins, and her Amendment 59, which is very appropriate. I hope my noble friend will look favourably on it, and I pay tribute to the work of the noble Baroness. One of her remarks earlier on Report which struck a chord with me was about the shortage of psychiatrists and other mental health professionals, particularly for those in the age group affected by these amendments.
I endorse and support the amendments in the name of my noble friend Lord Farmer. He refers in particular to the family hubs, and I make a plea to the Minister to recognise, as part of a family hub, a child contact centre. Centres are usually manned by volunteers, and they do fantastic work—not necessarily in keeping families together, because, unfortunately, their role largely comes into play when families have broken, but they play a fantastic role in maintaining contact with the absent parent.
Obviously, in these constrained times, the budgets of all organisations come under increasing scrutiny and pressure, so I urge the Minister to use his good offices to speak to those in the Ministry of Justice and the Department for Education to ensure that the budget for child contact centres will be renewed not only for two years but for three years—the period promised earlier. Those centres do fantastic work, under great constraint, and I am proud to be associated with them. I wanted to use this opportunity to support the amendments and to urge my noble friend the Minister to use his good offices in this regard.

Baroness Wheeler: My Lords, I too welcome the government amendments—bur first I wish the noble Lord, Lord Shinkwin, all the best for a speedy recovery from his hospitalisation; I am sure everyone will join me in that. I welcome the government amendments to ensure that the Bill recognises how important sharing information on children’s health and social care across government departments and public authorities is to safeguarding and protecting them and to promoting their welfare. The commitment in Amendment 157 to reporting to Parliament within a year on implementation, and explaining where the use of the consistent identifier for each child would facilitate information-sharing, is a significant step forward, as is the emphasis on overcoming the barriers that stop services being joined up, which have a serious—and, sadly, all too often fatal—impact on keeping children safe and well.
We also support government Amendment 36 to Clause 20, which leads this group, on how ICBs’ joint forward plans will address the needs of children and young people. Amendment 59 tabled by the noble Baroness, Lady Hollins, complements this in relation to performance assessments, and says how they should address the matter, particularly the duties relating to disabled children and children with special needs. I hope the Government will respond positively to this and will consult widely with stakeholders, after the promise in the Minister’s recent letter of a package of “bespoke” statutory guidance from NHS England explaining how ICPs and ICBs will meet the needs of babies, children, young people and families, and be accountable for integrating services. The Minister’s letter, and his introduction today, provide a number of assurances on important issues, such as having children’s leads on ICB executives. We will see how it all works through in practice in the structures of the new bodies.
As noble Lords have stressed, the whole issue of sharing information across multiagencies will be difficult and challenging. Two of the major barriers for previous efforts were the clash between the value of sharing electronic information and fears about it getting into the wrong hands. That is why we need a clear status picture of where we are starting from, to be able to analyse what needs to be done, how progress can be made, assessed and monitored, and the priority areas for identification of consistent identifiers.
The Minister has promised that the report will cover all safeguarding partners including the NHS, local authorities, education and the police. Will he write to noble Lords on the categories of information currently shared between those bodies, so that we can see where we are starting from?
Finally, the noble Lord, Lord Farmer, has again spoken strongly on his amendments about family hubs, which we supported in Committee on the Bill and on other occasions. I look forward to the Minister's updated response. We do, however, always—today is no exception—make the very obvious point that if the Government had not shut down the excellent Sure Start centres up and down the country, many of the provisions that the noble Lord is calling for in support of children, mothers and families would all be in place now.

Lord Kamall: I thank all noble Lords who have raised important points in this debate; I also thank them for accepting some of the amendments that we have tabled in response to their engagement. That engagement was very constructive, and I hope that as they look to hold the Government to account we will continue to have engagement on these issues.
First, I shall deal with a couple of specific questions. The noble Baroness, Lady Tyler, again asked about the identifier. As I have made clear, the report will include an explanation of the Government’s policy on a consistent identifier for children. It will also include our approach and actions to implement the recommendations in the report.
We all agree that the principle of a consistent identifier is right, but there are complex issues in applying that consistent identifier in safeguarding children. This is why we want to investigate all the issues thoroughly in a report that will be laid before Parliament a year after commencement. There is one issue in which I am personally interested—I am sure noble Lords will remember that I geeked out on this one. I think there are some technical solutions, but I can also see some technical unintended consequences. I myself will look very closely at the report, especially at the technical solutions.
Like other noble Lords, I welcome my noble friend Lord Shinkwin; it is good to see him back. I thank him for engaging with me—almost from his hospital bed, I think, which demonstrates his commitment to these issues. He talked about speech and language therapy, and the Government recognise the importance of communications needs, and the important part that they play in children’s development. We will work with stakeholders on the development of guidance, and ensure that we engage with the Royal College of Speech and Language Therapists.
I now turn to Amendment 59 brought forward by the noble Baronesses, Lady Hollins and Lady Tyler. The Government and NHS England are committed to ensuring that ICBs specifically consider the needs of babies, children and young people. NHS England performance assessments will look at a number of the ICB duties, including improvement in equality of service and how to reduce health inequalities. These duties apply to the whole population, including babies, children and young people. The Bill also places a duty on NHS England to have regard to any guidance published by the Secretary of State in connection with assessing the performance of ICBs each year. The guidance can include provisions for the assessment particularly to consider children and young people.
The Bill also places a new duty on the Care Quality Commission to review integrated care systems. The Bill proposes that these assessments will review how ICBs, local authorities and providers of health, public health and adult social care services are working together to deliver safe, high-quality integrated care to the public, including children and young people. The amendment addresses ICBs’ duties in relation to safeguarding children, including those with special education needs and disabilities. To ensure appropriate  accountability for duties, we have an agreement with NHS England that its statutory duty will provide that the responsibility for those functions should be delegated to an ICB executive lead. NHS England statutory guidance will clarify that the ICB annual report must set out how it has discharged its duties in relation to child safeguarding.
We should also look at issues around the 2021 Alan Wood review. The cross-government Safeguarding Children Reform Implementation Board, which DHSC jointly chairs, reviewed Sir Alan’s recommendations, and Ministers have discussed them with him. Officials continue to work with Sir Alan to embed his findings where appropriate.
I now turn to Amendments 64, 66, 68 and 75 and thank my noble friend Lord Farmer for bringing this important topic before the House and for engaging and pushing us on this issue which is clearly very close to his heart. We agree that ICPs and ICBs should work closely with a range of organisations to consider the whole needs of families. I stress that it is important that there should be a degree of local flexibility, as we discussed earlier. The package of bespoke guidance, which I mentioned previously, will cover services that my noble friend considers part of family help and the role that family hubs can play. We intend to include in statutory integrated care strategy guidance that family hubs, where appropriate, should be considered in the integrated care strategy where there are opportunities to integrate further its arrangements with health and social care services. My noble friend Lord Farmer will be aware that a range of work is ongoing in this area. The independent review of children’s social care is still considering the definition of family help, and it may be further refined as a result of the ongoing consultation. I would gently ask the noble Lords that the Government are given time to consider the review’s findings and recommendations.
My noble friend will also be aware of the upcoming ambitious programme of work with 75 local authorities to develop effective family hub models, but I must gently remind my noble friend and other noble Lords that as a matter of good governance, good law and the proper sequence of events, the Government feel that they must wait for the care review, and our work to develop family hub models at scale, before drawing implications for the statutory framework for either of them. Doing otherwise risks jumping the gun or being premature. While the Government strongly support and champion in principle the move to family hub models, they need to be able to adapt to local needs and circumstances. They also need to operate affordably, making use of a diverse range of local and central funding streams. In both these regards, local democratically elected councils hold the ultimate decision-making power over whether to adopt a family hub model and how it should function. Although I note my noble friend’s welcome efforts to soften its impact, we believe that there is still a risk that Amendment 75 would impose an additional burden on local authorities in their delivery of local services. It is for these reasons that I ask my noble friend and noble Lords not to move their amendments when reached.

Lord Mackay of Clashfern: Before my noble Lord sits down, does “children” in this amendment include children in care?
Amendment 36 agreed.
Amendments 37 to 54 not moved.

Amendments 55 to 58

Lord Kamall: Moved by Lord Kamall
55: Clause 20, page 24, leave out lines 39 to 43 and insert “sections 14Z34 to 14Z44 and 14Z47A (general duties of integrated care boards),”Member’s explanatory statementThis amendment requires the annual report for an integrated care board to explain, in particular, how it has discharged its duties under sections 14Z34 to 14Z44 and 14Z47A (rather than just some of those sections).
56: Clause 20, page 25, line 2, after “plan),” insert—“(ba) review the extent to which the board has exercised its functions consistently with NHS England’s views set out in the latest statement published under section 13SA(1) (views about how functions relating to inequalities information should be exercised),”Member’s explanatory statementThis amendment requires the annual report for an integrated care board to state how far it has exercised its functions consistently with views expressed by NHS England in the latest statement published under new section 13SA.
57: Clause 20, page 25, line 8, at end insert—“(3A) An annual report must include—(a) a statement of the amount of expenditure incurred by the integrated care board during the financial year in relation to mental health,(b) a calculation of the proportion of the expenditure incurred by the integrated care board during the financial year that relates to mental health, and(c) an explanation of the statement and calculation.”Member’s explanatory statementThis amendment requires an integrated care board to include in its annual report information about spending that relates to mental health.
58: Clause 20, page 25, line 25, at end insert—“(ca) section 14Z40 (duty in respect of research),”Member’s explanatory statementThis amendment requires a performance assessment in respect of an integrated care board to include, in particular, an assessment of how well the board has discharged its duty to promote research and the use of evidence obtained from research. Another amendment provides that the duty to promote research etc includes doing so by facilitating research.
Amendments 55 to 58 agreed.
Amendment 59 not moved.

Amendment 60

Baroness Brinton: Moved by Baroness Brinton
60: Clause 20, page 27, line 43, at end insert—“(3) This section however does not authorise—(a) the disclosure of patient information, or(b) the disclosure of personal information obtained from a specified authority which is a health or social care body.(4) For the purposes of this section a “health or social care body” means a public body which exercises functions in connection with the provision of health services or of adult social care in England.”  Member’s explanatory statementThis amendment would prevent ICBs from disclosing patient information or certain personal information.

Baroness Brinton: My Lords, I thank Ministers, officials and other Peers, including my noble friends Lord Clement-Jones and Lady Walmsley, and the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Finlay, for the discussions that we have had since Committee. I am particularly grateful for the letter from the Minister late yesterday and the meeting this morning.
I have laid Amendment 60, and I support Amendment 116, tabled by the noble Lord, Lord Hunt, which try to protect only the lawful disclosure of personal patient data. For the purposes of the debate on this group, can we accept that this is shorthand for the confidential personal and medical data currently mainly held by GPs and hospital doctors in England? Amendment 60 would provide that protection in legislation and was laid only because we have not yet had a clear response from Ministers on what is permitted and what the existing rules will be relation to ICBs taking over responsibilities from CCGs because ICBs are new bodies. This is in the light of new Section 14Z61. At Second Reading and in Committee, noble Lords expressed concerns that this new section, which outlines ICBs’ permitted disclosures of information, looks very wide ranging and could, for example, enable a police officer, or another person from a public body, to demand the disclosure of a patient’s personal data.
The new section uses the phrase that ICBs can disclose data where
“disclosure is necessary or expedient”
for the person making the request, but nowhere does it explain how the decision is made by the ICB or what the decision-making process is to release the data and, importantly, where the protection of that personal data sits in the hierarchy of the request of necessary and expedient demands. I have asked repeatedly how this process would work, and in responses at the Despatch Box, in meetings and in letters I have not really had a response that has laid out simply and clearly how this process would work. I shall therefore ask the Minister the following questions in an attempt to clarify how a patient’s confidential personal data will be protected and what the process would be for it to be released to a person making a request. What rules and guidance are available for staff, including those in ICBs, to manage a request from a non-NHS person requesting information other than through a court order? How would it be processed and reviewed? ICBs would not normally be the holder of such data, and new Section 14Z61 does not set out the balance between the rights of the patient and those of the requestor who believes they have a necessary or expedient reason for being sent this data.
We wish to be confident that the structures are in place for when shared care records come into force. Let me be clear: from these Benches, we welcome the principle of shared care records, but the processes need to be in place to ensure that personal data is protected when every part of NHS England would have access to that data. I raise this particularly because just this week Health Service Journal stated that the  Secretary of State is speeding up the shared care records project to be complete and implemented by December 2023.
Can the Minister therefore commit that the powers in Section 14Z61(1) will be constrained such that for requests of disclosure that come from outside the health and care system, the ICB will only ever disclose the direct care providers the requester could ask instead? Can he confirm that if an ICB is to become data controller for shared care records, he will return to this clause with primary legislation on such implementation?
I am very grateful for the discussion with Ministers and officials and hope that the Minister will be able to provide your Lordships’ House with a response that demonstrates that patient, personal and confidential data remains secure. I look forward to his response, and I beg to move.

Lord Hunt of Kings Heath: My Lords, first, I congratulate the noble Baroness, Lady Brinton, on the brevity of her remarks, which is a model for Report stage. I think she put this across very well indeed and I very much support her.
My Amendment 116 relates to the containment in the Health and Social Care Act 2012 of the concept of a safe haven for patient data across health and social care, which is required for national statistics for commissioning, regulatory research purposes and patient care. My Amendment 116 simply seeks to keep those statutory protections in place and ensure that NHS England does not take on this responsibility as a result of the merging of NHS Digital and NHSX within the structure of NHS England, which was a recommendation of the review led by Laura Wade-Gery. The noble Lord, Lord Clement-Jones, is going to speak in some detail—but with brevity as well, I hasten to add.
Kingsley Manning, the former distinguished chair of NHS Digital, has spelled out the implications of doing this. He believes the action of NHS England in taking over NHS Digital
“is a significant retrograde step in defending the rights of citizens with respect to the collection and use of their health data.”
In a letter to me, which I received yesterday, the Minister asked me why NHS England would be regarded as less independent, transparent or objective in the exercise of these functions, given its already significant responsibility for some data and the fact that it is a very similar organisation to NHS Digital, as a statutory arm’s-length body. In answer to him, NHS England has many different responsibilities and priorities, so, first, it will clearly not be able to give the same focus to the issue of protecting the safe haven and, secondly, it has many interests which could be deemed to at least be in tension with the concept of the safe haven. That is why I and other noble Lords believe it is important to have the statutory protection already contained in the current legislative arrangements.
I conclude by saying that I am at one with Ministers in wanting to speed up digital transformation in the NHS; after all, we have been dabbling with this over many years. But it has to be done right, and the way to do it right is to be very transparent and rigorous about the protection of patient information.

Lord Clement-Jones: My Lords, I rise briefly to speak to Amendments 60 and 116, and I congratulate my noble friend Lady Brinton and the noble Lord, Lord Hunt, on their persistence in pressing these two items, because they are extremely important. I also thank the Minister for his engagement, both on the Floor of the House and in extensive correspondence. This has been really quite a complicated trail. I feel as though we have been in a maze where we have had to follow a bit of string, finding the way through into data governance in the NHS.
We have had to follow certain key principles, which we all share and which the Minister has expressed, including the protection of privacy, the right of opt-out, the value of health data and, above all, the imperative to retain public trust. Given the importance of the new ICB regime, I very much hope that the Minister will be able to comprehensively answer my noble friend’s questions.
But if we have taken the time to get to this point of really understanding—or beginning to understand—the kind of data governance that the ICBs will be subject to, it raises the question of what future guidance will be in place. I very much hope that the Minister can absolutely give us the assurance that there will be new, clear guidance, along the lines I hope he is going to express in response to my noble friend, as soon as possible, especially given the speeding up of the electronic patient record programme, as my noble friend Lady Brinton said. That is, of course, desirable, but it has to be done in a safe manner.
As regards Amendment 116, the Minister in his letter—which the noble Lord, Lord Hunt, addressed in his response—seemed a bit affronted that we should raise the credentials of NHSEI as a holder and protector of NHS data. I would refer to the BMJ letter, which I think came online yesterday, from Kingsley Manning, a former chair of NHS Digital. He really does set it all out. I shall not go into great detail but, for instance, he says that merging NHS Digital with NHSE
“is an important and retrograde step.”
Your Lordships may dispute this, but from where he sat this is important. He said:
“In my experience the general approach of NHS England, including of its clinicians, was that much of the guidance and regulations with respect to the use of patient”
data “was seen as unnecessary”. That is a pretty big statement and a fairly damning verdict from the former chair of NHS Digital. I do not think that the Minister can simply remedy the situation by assurances, so I support the amendment in the name of the noble Lord, Lord Hunt, and if it is put to a vote, I very much hope that the House will support it.
Finally, whether or not these amendments are pressed, I hope that the Minister will reconsider whether the Goldacre review should be published before the final version of the new NHS data strategy, Data Saves Lives. I welcome the fact that the Goldacre review is going to deal with information governance, but it is important that we should see that before the final version of Data Saves Lives.

Lord Warner: My Lords, I rise even more briefly to support Amendment 116. It is worth reminding the Minister and the House that the Government  Statistical Service is independent. It was made so by the Blair Government so that Ministers could not withhold, distort or delay the publication of uncomfortable statistics. Rebukes on dodgy statistics secure public reprimands of Ministers and departments.
The logic of this position is that you do not put the collection or publication of health statistics in the hands of an operational arm’s-length body, particularly because there could be a conflict of interest. That point has already been made. These functions should be left in the hands of an independent non-operational body, which is what the amendment in the name of the noble Lord, Lord Hunt, does. Can the Minister explain why the Government are making this change? My instinct is to be mightily suspicious.

Baroness Walmsley: My Lords, I simply rise to say that I agree with all noble Lords who have spoken and look forward to the Minister’s reply.

Baroness Merron: My Lords, I rise to share all the concerns expressed about the open-endedness of what is in the Bill and the concerns about the lack of protection for patient data. Clearly, there has been much debate and discussion, and I think it is right that we hear from the Minister.

Lord Kamall: My goodness—I thank noble Lords for their brevity. I am afraid that I shall not be as brief as I would want to be. I would like to confine myself to single-word answers, but I do not think that would give the reassurance that noble Lords are looking for.
I begin by thanking all noble Lords who have engaged with me on this, especially the noble Baroness, Lady Brinton, and the noble Lords, Lord Clement-Jones and Lord Hunt. As they know from our discussions, this issue is very close to my heart and something I feel very strongly about, so I welcome their pressing the Government on this and their continuous engagement—in fact, right up to this morning. I do not think that this is the end of that engagement but I hope to give some reassurances. I completely understand the interest in the integrated care boards’ power to disclose information that is personal data. I hope I will be able to clarify some of the intentions.
New Section 14Z61, inserted by Clause 20, recreates the section that applies to CCGs, which sets out the circumstances in which CCGs are permitted to disclose information obtained in the exercise of their functions. The clause in question already restricts ICBs’ powers to disclose information, by limiting these to the specific circumstances set out in the clause.
In addition, the existing data protection legislation, including UK GDPR, provides several key protections and safeguards for the use of an individual’s data, including strict rules and key data protection principles for the sharing of personal data. Health data is special category data—that is data that requires additional protections due to its sensitivity. For this type of data to be processed lawfully, a further condition must be met as set out in UK GDPR and the Data Protection Act.
In addition, the common law duty of confidentiality applies to the use of confidential patient information. This permits disclosure of such information only where the individual to whom the information relates has consented, where disclosure is of overall benefit to a patient or is in the public interest—for example, disclosure is to protect individuals or society from risks of harm or where there is a statutory basis for disclosing the information or a legal duty, such as a court order, to do so.
Every health and care organisation has a Caldicott Guardian—a senior person responsible for protecting the confidentiality of people’s health and care information and making sure that it is used properly. Caldicott Guardians decide how much information it is appropriate to share—they may decide that even legally permitted information may not be shared—and they advise on disclosures that may be in the public interest. They act in accordance with the eight principles, which are the framework to ensure that people’s confidential information is kept confidential and used appropriately. The UK Caldicott Guardian Council works closely with the independent statutory National Data Guardian, whose role is to advise and challenge the health and care system to help ensure that the public’s confidential information is safeguarded securely and used properly.
Nothing in the clause overrides the range of requirements in law that provide key protections and safeguards for the use of an individual’s personal data. I can also confirm that NHS England’s power to issue guidance for ICBs will apply to their functions relating to data sharing, and that may be a helpful route in making it clear to ICBs what their duties and responsibilities are, in respect of any confidential data they may hold, in a way that illustrates how legislation applies.
The effect of the amendment is to prevent the effective operation of the clause as drafted. This would prevent the ICB from effectively discharging its functions where it may be necessary to disclose personal patient data, including investigating complaints, making safeguarding referrals for patients whose welfare is at risk, complying with court orders and assisting criminal investigations. It would also risk a confusing data-sharing system where different rules apply to different organisations.
On Amendment 116, once again I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this issue before this House. Our aim is to put data and analytics at the heart of NHS delivery and remove incoherence in the organisational leadership, for the benefit of patients and their outcomes. It is a solid recommendation for improving how health and social care data is used more effectively, closing that gap between delivery and the use of data to inform and improve services.
I understand that noble Lords fear that the movement of the statutory data functions from one world-class arm’s-length body, NHS Digital, to another, NHS England, which indeed runs the NHS itself, would result in a decline in the exercise of those functions. We feel that this fear is perhaps overexaggerated but I would be very happy to continue discussions on this.
However, that movement would be accompanied by the transfer of several thousand expert staff and all their supporting expertise and technology, along with the existing statutory safeguards, which would be preserved. NHS Digital and NHS England have a history of very close working on data, most recently of course in how the management of data has underpinned efforts to defeat Covid-19, through the protection of shielded patients and the management of data on vaccinations. The Government and Parliament held NHS Digital to account for the delivery of its functions, and they will continue to hold NHS England to account for the delivery of any functions which transfer.
As to the concern about a conflict of interest, the data collections which NHS Digital undertakes are the result of directions from either the Secretary of State or NHS England, and obviously the direction-making power of the former will continue to be relevant should the proposed merger take place. Directions include details of how data must be shared or disseminated. NHS Digital is required to publish details of all such directions and maintain a register of the information it collects. There is also a rigorous process for external data access requests and audits of how data is used.
The intention here is that such safeguards would continue when the functions transfer to NHS England and would make it very difficult for the organisation to suppress or otherwise refuse to make available any data which it is required to collect and disseminate in fulfilment of its statutory role. I hope, perhaps overoptimistically, that I have reassured the noble Lord, Lord Warner—clearly not—in terms of suppressing information.
There is a rigorous process for external data access requests. NHS England’s Transformation Directorate will be assuming responsibility for NHS Digital’s functions, and for accomplishing the alignment of delivery and data proposed in the Wade-Gery review. There will continue to be external, independent scrutiny—for example, by the Information Commissioner and the National Data Guardian—of the use by the NHS, and NHS England in particular, of health and care data.
I hope that I have given noble Lords some reassurance that these important issues have been considered by the department, and that they will feel able not to move their amendments when reached. Of course, given my strong interest in this subject, I am prepared and happy to have further conversations to make sure that we close any remaining gaps and for me push the department and NHS England as appropriate.

Baroness Pitkeathley: I now invite the noble Baroness, Lady Brinton, who is taking part remotely, to reply to the debate.

Baroness Brinton: My Lords, I thank all noble Lords who have contributed to this debate, in particular for their brevity given the long day we have ahead of us. In particular I thank the Minister for his helpful response.
My Amendment 60 is very specific and I asked for a specific response. The Minister has confirmed what I wanted to hear: that health data is special category data, and that it requires additional protections due to  its sensitivity, which would be applied by any ICB when it has had that request. The other key phrase that stuck out was that nothing in the clause overrides the range of requirements in law to provide those key protections and safeguards regarding individual personal data. I am therefore satisfied on that basis.
Briefly on Amendment 116, which is much broader in scope and very important for the future of data use with the proposals that are coming down stream, I agree with all the comments that were made by noble Lords. One particular thing that stood out for me was the proposal of the noble Lord, Lord Clement-Jones, that the publication of the Goldacre review is vital before any final version of Data Saves Lives is made public.
We will not get to a vote on Amendment 116 today. However, could the Minister assist the House and confirm that guidance will be issued, rather than a looser “may be” issued? With that, I beg leave to withdraw my amendment.
Amendment 60 withdrawn.

  
Clause 21: Integrated care partnerships and strategies

Amendment 61

Lord Lansley: Moved by Lord Lansley
61: Clause 21, page 29, line 14, leave out from “committee” to the end of line 20 and insert “(an “integrated care partnership”) for the board’s area.(2) The integrated care partnership may be designated as the Health and Wellbeing Board where the area of the integrated care board and the responsible local authority are coterminous.(2A) If more than one Health and Wellbeing Board relates to the area of the integrated care board, the integrated care partnership may be designated as the Health and Wellbeing Boards of each responsible local authority acting in combination.(2B) The integrated care partnership must consist of—(a) one or more members appointed by the Health and Wellbeing Board or Boards,(b) members appointed by the integrated care board (equivalent in number to the number appointed by the Health and Wellbeing Board or Boards), and(c) such further members as are appointed by the integrated care partnership.”

Lord Lansley: My Lords, Amendments 61, 95 and 96, which are all in my name, are to two separate issues. Amendment 61 relates to an issue we debated a number of times in Committee, when, if I may presume, there was a degree of support among noble Lords for the proposition that integrated care partnerships, in so far as they have to produce a strategy for a needs assessment for their area, have a very complementary—indeed, one might say overlapping—responsibility with health and well-being boards established in local authorities.
I will not go into the detail of how this works, and nor do I rest on the construction of Amendment 61. I freely acknowledge that this is a tricky thing to do. There will be circumstances where one ICS, one ICB or one ICP covers a lot of local authorities and others where it covers only one or two. In the latter case, it is  pretty straightforward to integrate health and well-being boards and integrated care partnerships. In other cases, the membership and construction may be more complicated.
Essentially, I want to ask my noble friend a very simple question. We hope it may be possible for integrated care partnerships and health and well-being boards to work together. In certain circumstances, it might also be concluded that they should essentially be the same organisation, since they do the same or similar jobs. How does the legislation permit this to happen?
Previously, we said that the link between this and Amendments 95 and 96 was that, for a number of years, the NHS has engaged in activities and has been structured and organised in ways which it says are not supported by legislation. We do not have to debate whether or not this is so. The point is that the structure of this Bill was intended to enable the NHS to have legislation that directly supports the way in which it proposes to work organisationally in future.
Ten days ago, the Government published a further integration White Paper. As noble Lords will recall, among other things it said that there should be a single person accountable for shared outcomes in each place. It said:
“Our focus in this document is at place level.”
It went on:
“Success will depend on making rapid progress towards clarity of governance and clarity of scope in place-based arrangements.”
Amendments 95 and 96 are about where that place structure is. If the Government are looking to create legislation which reflects future ways of working, where is the place board?
Amendments 95 and 96 relate to Clause 62, which is about the process of delegating functions from NHS bodies to other bodies. In future, one of the essential delegations will be from integrated care boards to their place boards. Would it not make sense for Clause 62 to include place boards? Amendment 95 adds them to the list of relevant bodies, and Amendment 96 simply says what a place board is. The description is more or less non-controversial, although I do not rest on its drafting. Logic says that, if the Government are intending that place boards should exercise a significant function which will be delegated to them by local authorities and/or integrated care boards—potentially both—why not put them in the clause which arranges the delegation of functions? Otherwise, in a year or two, we may end up in exactly the position about which the NHS complained in 2016: that, in integrated care systems, something had been created which the legislation did not support. In a way, place boards reflect the structure of clinical commissioning groups, which have been established over a number of years and are now to be abolished. I am very worried that we will again end up in a situation where place boards are important, yet the legislation will not create a structure to allow this to happen.
I hope that my noble friend will be able to offer encouraging words about how this is to be achieved. It needs to be in the legislation to enable future arrangements to be supported. I beg to move.

Lord Scriven: My Lords, I support the amendments in the name of the noble Lord, Lord Lansley, and declare my interest as a vice-president of the Local Government Association.
There has been a whole debate at Second Reading and in Committee about the equality of local government and the NHS in this regard. Importantly, local government focuses on place because it is used to doing so. If, as the noble Lord, Lord Lansley, has said, the legislation does not include powers to delegate right down to local government so that it can work with the NHS—which it sees as its key responsibility—then there will be a gap, and this will not be seen as a true partnership. More importantly, the powers that would unleash some of the issues central to the Bill—better integration, reducing health inequalities and improving health outcomes—will not be achieved. There will not be the powers of delegation that will be allowed to place when innovation starts.
That is why the amendments tabled by the noble Lord, Lord Lansley, are important, particularly Amendment 96, on the roles of the place board. If the Government do not take this forward, it will be a total abdication. Place will be important in unleashing innovation, and the noble Lord, Lord Lansley, has rightly pointed out this gap in the legislation.

Baroness Walmsley: My Lords, the noble Lord, Lord Lansley, has made some important and sensible points, and I look forward to hearing the Minister’s reply.
My noble friend Lord Scriven raised the important question of the role of local authorities. I simply want to add that I happen to know that some of the chairs-designate of the ICBs would really like to know the answer to the question posed by the noble Lord, Lord Lansley, early on in his speech. What is the relationship of the health and well-being boards to the ICBs? If those people are confused, it is not surprising that noble Lords are too.

Baroness Thornton: My Lords, the noble Lord, Lord Lansley, has once again put his finger on an issue that the Government need to take seriously and which, as the noble Lord, Lord Scriven, said, has run through our debates at Second Reading and in Committee. What is the role of the ICPs’ joint working and what should a place board be doing? As I said during the previous day’s debate on Report, we need also to treat place boards—or any commissioning body—in the same way as we do the ICBs.
The noble Lord, Lord Lansley, is right. If the Government do not address this issue in the next few weeks by putting something in the Bill, we may well find ourselves back here in two or three years’ time, doing exactly what we are doing now.

Baroness Penn: My Lords, this has been an important discussion about place and joint working, and although the Government are unable to accept my noble friend’s amendments, for reasons I shall touch on, I hope I can reassure him that the questions which he and other noble Lords have raised have been considered in the Bill.
England is so large and diverse that a one-size-fits-all approach will not be right for everyone, and that is why we have been flexible about the requirements for integrated care partnerships and joint working arrangements. We fundamentally believe that, if integration is to work, we must allow local areas to find the right approach for them.
As my noble friend will appreciate, our provisions on integrated care partnerships build upon existing legislation, particularly in the case of health and well-being boards. We know that health and well-being boards have played an incredibly important role in the last decade, and this legislation intends to build on their success. We will be refreshing the guidance for health and well-being boards in the light of the changes that this Bill proposes, in order to help them understand the possibilities of these arrangements and their relationships with ICBs and ICPs, so that they can find the most appropriate model for their area.
Fortunately, this Bill and existing legislation already provide the framework to do what these amendments intend to achieve. Two or more health and well-being boards can already jointly exercise their functions, and where the local authority area and ICB area are the same, there is no reason why the health and well-being board and the ICP cannot have the same membership. The ICP is intended as an equal partnership between the local authorities and the ICB. By restricting the right of the local authority to nominate a member who they see fit and requiring them to do so through a committee with a potentially wide membership, including the ICB, risks undermining that equality. Local authorities may ask their health and well-being board to nominate those members. However, we do not wish to restrict their options and unintentionally prevent better collaboration and integration by adding further requirements to the Bill.
I turn to the joint working arrangements. The Bill also provides for the ability to establish place-based committees of ICBs and to set them out clearly in their constitutions. I assure my noble friend on this point that the legislation allows the flexibility to establish these committees, so we should not find ourselves in the situation that he talks about. ICBs will be able to enter arrangements under new Section 65Z5, which allows an ICB to delegate or exercise its functions jointly with other ICBs, NHS England, NHS trusts, foundation trusts and local authorities, or any other body prescribed by regulations. Under these powers, a committee of an ICB could be created to look at population health improvement at place level and could consider entering an arrangement under Section 65Z5 to work jointly where appropriate.
The membership of that committee can be decided locally by the ICB, and it is entirely open to the ICB to seek views from other organisations as to who best to appoint. I hope that reassures my noble friend that there is already the legal framework for ICBs to look at population health improvement at a place level. We are trying to protect the ability of ICBs to determine the structures that work best for them. To help them to do that, NHS England has the power to issue guidance to ICBs on the discharge of their functions. The flexibility that we have set out in the Bill makes my noble friend’s intentions possible. However, our provisions  also give a degree of flexibility, so that areas can take control, innovate, and adopt what works best for them, rather having to meet prescriptive top-down requirements.
It is for these reasons that I hope that my noble friend feels able to withdraw his Amendment 61 and not move his Amendments 95 and 96 when they are reached.

Lord Lansley: My Lords, I am most grateful to noble Lords for their support, and to my noble friend for responding. I have a couple of important things to say.
First, I was not suggesting these things. I was suggesting that the legislation should reflect what the Government’s intentions are, because the integration White Paper set them out. Secondly, my noble friend said very carefully that the health and well-being boards and integrated care partnerships can have the same membership, but that is not the same as them being the same organisation. I am looking for my noble friend to say, without fear of contradiction, that where they choose locally to do so—and I am perfectly happy for there to be flexibility—local authorities and the ICBs can create an integrated care partnership which serves the functions of the health and well-being boards and the integrated care partnership in one organisation. That is the question.
On Amendments 95 and 96, I take the Minister’s point. I looked at it and thought, yes, there’s no difficulty about the place boards being a committee of the integrated care boards, but the Government in their White Paper said that there should be a single person accountable for shared outcomes in each place. That place board would have functions delegated to it from the integrated care board and local authorities. For that to happen, I cannot understand why it is not necessary for that to be reflected in Clause 62, since the existing legislation makes no reference to place boards. Also, if the person who is accountable is the chief executive of the place board, we must assume that that will not necessarily be the chief executive of the integrated care board, yet as things stand in the legislation, the chief executive of the integrated care board will be the single accountable officer. How is the accountable officer to be the chief executive of the place board?
I raise those questions. I will gladly withdraw my amendment at this stage and not move Amendment 95 and 96 if we reach them today, but I hope that my noble friend and her colleagues will look at this and be certain that they have covered this off before we complete the passage of the Bill. I beg leave to withdraw my amendment.
Amendment 61 withdrawn.
Amendments 62 and 63 not moved.

Amendment 64

Lord Farmer: Moved by Lord Farmer
64: Clause 21, page 30, line 1, leave out “may” and insert “must”Member’s explanatory statement  This amendment and others to Clause 21 and Schedule 4 in the name of Lord Farmer would require integrated care partnerships to consider how to integrate health-related services into the provision of health and social care services, and specifically family help services, as relationships are recognised by research as a “health asset”. “Family help” is defined in accordance with the Independent Care Review’s starting definition. ‘Family hubs’ are named as key potential sites for delivering integrated paediatric health and family help.

Lord Farmer: My Lords, I want to respond to Amendment 64.

Baroness Pitkeathley: Amendment 64 has already been spoken to.

Lord Farmer: But I did not withdraw it. I was waiting for the response; nor did I have a chance to say whether or not I would divide the House.

Baroness Penn: The noble Lord is correct that he can speak to Amendment 64 and, in doing so, move it, but he should then choose to withdraw it or test the opinion of the House.

Lord Farmer: I thank the noble Baroness, Lady Tyler, and other noble Lords, for their support, and I thank the Ministers for helping on the direction of travel for family hubs, and for family hubs being included in statutory guidance for integrated care services and bespoke guidance specifically covering family help. However, we are talking about the bronze medal position. Gold medal is primary legislation, silver is secondary, and statutory guidance is bronze, although at least we are on the podium. As the Minister said, this is ongoing. They are awaiting the review of children’s local care evaluations from 75 local authorities. I will be with them on the journey. That is all that I can say, as it is ongoing.
Amendment 75 still presents a possible risk of imposing an additional burden on local authorities in their delivery of local services. Given that I have mirrored what the Children Act 1989 says regarding now defunct family centres, the Government should really consider amending this themselves if it inappropriately burdens local authorities. In any event, I welcome the Government’s movement. I beg to withdraw my amendment.
Amendment 64 withdrawn.
Amendments 65 to 68 not moved.

  
Clause 26: Care Quality Commission reviews etc of integrated care system

Amendment 69

Lord Lansley: Moved by Lord Lansley
69: Clause 26, page 37, line 24, leave out “objectives and”

Lord Lansley: My Lords, this group of amendments in my name relates to Clause 26. Noble Lords will recall that we had a rather helpful debate   about this in Committee. The point is that the Care Quality Commission is an independent organisation. We want to respect that and see that carried through into its new responsibility of reviewing and inspecting the integrated care systems.
The Bill asks for “objectives and priorities” to be set by the Secretary of State. In another place, Members of the Commons inserted the idea that these priorities must include—as seen in proposed new Section 46B(3)—
“leadership, the integration of services and the quality and safety of service”.
That is fine; if they want that, let us leave it in, but I have no idea what “objectives” are in this context. Although I do not want to go down the path of semantics, for the Secretary of State to say what his or her priorities are is entirely reasonable and should be reflected in the indicators used by the CQC, but I am not sure that I know what “objectives” are in this context. Either my noble friend will explain to me what the objectives are, in which case the question of why they are not clarified further in the Bill arises, or let us leave them out—which is what most of these amendments do.
Regarding two of these amendments, it seems particularly undesirable for the Secretary of State—as in proposed new Section 46B(5) and (10)—to
“direct the Commission to revise the indicators”.
The indicators that the Care Quality Commission devises require the approval of the Secretary of State, so I am not sure why we should so trammel the independence of the CQC by enabling the Secretary of State to “direct” it to revise its indicators as opposed to denying approval, so I would rather that were not there.
Our noble friends on the Front Bench have been very accommodating; a spirit of compromise and understanding seems to have imbued the Front Bench splendidly so far. If the Minister is not minded to accept my amendments, I hope that she can at least give me some reassurance about the manner in which the Secretary of State’s powers are to be used or—in my view, this would be better—not used or extremely rarely used. I beg to move Amendment 69.

Baroness Walmsley: My Lords, the CQC is a competent and independent organisation. Long may that continue, and any attempt to trammel it is unwelcome. We have here a 265-page Bill. If the CQC cannot get from the Bill the intentions of the Government and carry them out carefully in doing its job inspecting and reporting on how the integrated care systems are working, I do not think it needs any further direction from the Secretary of State.

Baroness Thornton: I agree with that and with the noble Lord, Lord Lansley. We will be coming to other issues about the Secretary of State’s powers later on Report, but the noble Baroness, Lady Walmsley, has put her finger on it. I think I was there at the CQC’s inception because I was a Minister at the time, or certainly soon after. It has discharged its duties extremely well. The Minister needs to explain why the Government feel it necessary to put these powers into the Bill.

Baroness Penn: My Lords, I thank my noble friend for raising this issue. I hope in the spirit of collaboration and compromise I am able to provide him with some further clarity and reassurance, even if I am not able to support his amendments.
Flourishing systems are critical to the success of integration and many of the proposals in the Bill. In that context it is right that the Secretary of State, who is accountable to Parliament, can set the overall strategic direction of reviews of integrated care systems through setting objectives and priorities for the CQC in relation to those assessments. However, it will be the CQC as the independent regulator and expert which will develop and carry out those reviews.
In Committee, noble Lords across this House raised several matters that these reviews should or could look at—from children to rare conditions—and it is right that the Secretary of State should be able to set objectives to explain the intent that lies behind high-level priorities such as leadership, integration quality and safety. These objectives will aid the CQC in its development of the review methodology and quality indicators and lay out where specific focuses should be given. The current clause allows the Secretary of State to make these distinctions and be more nuanced, just as is permitted for CQC reviews of local authority functions relating to adult social care set out in Clause 152. To remove the Secretary of State’s ability to set objectives is to remove nuance, which in turn could dilute the focus of these reviews on particular patient pathways or integration arrangements.
Furthermore, the Secretary of State must be able to ensure that the CQC’s role is complementary to other assessments, such as NHS England’s oversight of ICBs. This is achieved in part through the Secretary of State’s role in approving and directing to revise the indicators of quality, methods and approach. Removing the Secretary of State’s ability to direct the CQC to revise indicators risks the Secretary of State being locked in after approving the methodology. This could prevent the Government being able to respond to shifting developments in health and care, thus undermining the review’s relevance as time progresses.
I further reassure my noble friend and other noble Lords that we expect the power to direct to revise to be used infrequently, so as not to disrupt CQC reviews. The Government fully respect the independence of the CQC, and these powers are designed to ensure that its reviews of the integrated care systems are effective without undermining that independence.
It is for these reasons that I hope my noble friend feels able to withdraw his amendment and not move his further amendments when they are reached.

Lord Lansley: I am most grateful to my noble friend and for the support of noble Lords for the concept. I hope the CQC will find that this assists it in ensuring that it remains independent in how it goes about its job, and, indeed, how it derives indicators of quality and fitness for purpose. I take my noble friend’s point about what objectives might be. They might be, for example, objectives of the nature of the service that the review should cover so the Government might have some national priorities. I think the word “priorities” would have been sufficient.
I confess to my noble friend that I did not understand why the Secretary of State might come in and direct the CQC to change its indicators. It would have been perfectly reasonable for the Secretary of State to have waited and seen what the CQC said. The CQC will clearly change its indicators from time to time as technologies and services adapt, and it could have been trusted to do it. I will not press the point and I beg leave to withdraw Amendment 69.
Amendment 69 withdrawn.
Amendments 70 to 74 not moved.

  
Schedule 4: Integrated care system: minor and consequential amendments.
  

Amendment 75 not moved.

Amendments 76 and 77

Baroness Penn: Moved by Baroness Penn
76: Schedule 4, page 173, line 29, at end insert—“Armed Forces Act 200682A_(1) Section 343AA of the Armed Forces Act 2006 (due regard to principles: England)(as inserted by section 8(3) of the Armed Forces Act 2021) is amended as follows.(2) In subsection (3), for paragraph (h) substitute—“(h) an integrated care board;”.(3) In subsection (8)—(a) omit the definition of “clinical commissioning group”;(b) at the appropriate place insert—““integrated care board” means a body established under section 14Z25 of the National Health Service Act 2006;”.”Member’s explanatory statementThis amendment is consequential on Clause 14 of the Bill, which establishes integrated care boards.
77: Schedule 4, page 193, line 14, at end insert—“Police, Crime, Sentencing and Courts Act 2022239_ The Police, Crime, Sentencing and Courts Act 2022 is amended as follows.240_(1) Section 25 (relevant review partners) is amended as follows.(2) In subsection (2)(c) for “a clinical commissioning group” substitute “an integrated care board”.(3) In subsection (3)(c) for “clinical commissioning group” substitute “integrated care board”.241_ In section 36 (interpretation), in subsection (1)—(a) omit the definition of “clinical commissioning group”;(b) at the appropriate place insert—““integrated care board” means a body established under section 14Z25 of the National Health Service Act 2006;”;(c) in the definition of “review partner”, for paragraph (c) substitute—“(c) an integrated care board, or”.242_ In Schedule 1 (specified authorities and local government areas), in the table headed “Health and social care”—(a) for “A clinical commissioning group established under section 14D” substitute “An integrated care board established under section 14Z25”;  (b) for “the group’s” substitute “the board’s”.”Member’s explanatory statementThis amendment is consequential on Clause 14 of the Bill, which establishes integrated care boards.
Amendments 76 and 77 agreed.

  
Clause 29: Exercise by NHS England of new regulatory functions

Amendments 78 and 79

Baroness Penn: Moved by Baroness Penn
78: Clause 29, page 39, line 34, leave out “also”Member’s explanatory statementThis amendment is consequential on the insertion into section 13U of the NHS Act 2006, by another amendment, of a duty for NHS England to include additional matters in its annual report.
79: Before Clause 35, insert the following new Clause—“Duties in respect of researchIn section 1E of the National Health Service Act 2006 (duty as to research), after “must” insert “facilitate or otherwise”.”Member’s explanatory statementThis Clause provides that the Secretary of State’s duty to promote research etc includes doing so by facilitating research.
Amendments 78 and 79 agreed.

  
Clause 35: Report on assessing and meeting workforce needs.

Amendment 80

Baroness Cumberlege: Moved by Baroness Cumberlege
80: Clause 35, page 42, leave out lines 14 to 19 and insert—“(1) The Secretary of State must, at least once every two years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.(2) This report must include—(a) an independently verified assessment of health, social care and public health workforce numbers, current at the time of publication, and the projected workforce supply for the following five, ten and 20 years; and(b) an independently verified assessment of future health, social care and public health workforce numbers based on the projected health and care needs of the population for the following five, ten and 20 years, taking account of the Office for Budget Responsibility long-term fiscal projections.(3) NHS England and Health Education England must assist in the preparation of a report under this section.(4) The organisations listed in subsection (3) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence and plans provided by local organisations and partners of integrated care boards.”Member’s explanatory statementThis amendment would require the Government to publish independently verified assessments every two years of current and future workforce numbers required to deliver care to the population in England, taking account of the economic projections  made by the Office for Budget Responsibility, projected demographic changes, the prevalence of different health conditions and the likely impact of technology.

Baroness Cumberlege: My Lords, as this is Report, I declare my interests, which are that I am employed by NHS England to implement my report on maternity, Better Births.
I shall speak to Amendment 80. I want to thank the noble Lord, Lord Stevens of Birmingham, and the noble Baronesses, Lady Walmsley and Lady Merron. I am really grateful for their cross-party support.
I have had a lot of support for the amendment not only from the whole House, which is very welcome, but from 100 organisations including 16 royal colleges and many important charities. I shall mention just two charities out of the large number from which I have received support: National Voices, which speaks for patients, and YoungMinds—because it is their future that we are talking about. A huge number of patient groups, think tanks and professional bodies have also supported this amendment.
We spoke in Committee about workforce planning. I say to my noble friend the Minister that the strength of feeling on this matter has been great. I make no apology for bringing back this amendment today. Workforce is the single greatest problem facing the NHS. Without improved planning, we will fail to tackle the growing backlog not only in procedures but in appointments within the NHS. We will not know whether we have the right people in the right place at the right time. We will not provide a sustainable work environment for the dedicated staff currently working so hard within our services. We will not meet the public’s expectations when they turn to the NHS for care and support.
In Committee, my noble friend the Minister said that we had a record number of people working in the health service. I do not doubt him for a moment, but it begs the question of whether we have enough to meet demand. Staff numbers may be rising, but so is the backlog. The current NHS waiting list stands at 6.1 million and is rising. We need workforce capacity that can meet not only today’s demand but that of the future. As we all know and have discussed in this Chamber, it take many years to train nurses, doctors and health professionals. We need a long-term view. Without that, we are flying blind.
The NHS is relying more and more on bank and agency staff. Not only is that expensive but it is a sticking-plaster solution. We need a workforce strategy. The Secretary of State told the Health and Social Care Select Committee recently that he had commissioned NHS England to undertake a long-term workforce strategy but, again, that begs questions. We do not know whether the strategy will cover both healthcare and social care. That is essential if we want to improve integration within those services, which, after all, is the very purpose of the Bill—it is not called the Health and Care Bill for nothing.
We do not know what period the strategy will cover, or whether it will be regularly refreshed. We do not know whether it will include numbers of staff needed  based on population demand. A workforce plan without numbers simply does not add up. We need clear, verifiable, objective data and analysis to underpin such a strategy, and to enable us to check at regular intervals whether that strategy is working.
When I spoke in Committee, I fear that I may have bombarded your Lordships with numbers—for unified staff vacancies, unfilled staff vacancies, retirement projections and so on. I used all those numbers to illustrate the workforce challenges faced by the health and care system, but I am sure that your Lordships will be grateful that I shall not repeat those today. I want just to say that the numbers are as telling now as they were in Committee; they are not getting better. They underline the need for a long-term plan, backed up by the data and analysis that Amendment 80 would bring. The longer we wait, the worse the situation becomes.
I have mentioned reliance on bank and agency staff. I need to say a very few words about that, because my sense is that behind the Government’s hesitation about this amendment is a concern about the cost complications that it could trigger. Training more healthcare staff will of course cost more money, but not training more staff costs money too. The mismatch between staffing levels and patient demand is leading to significant locum spend to plug the gaps. In 2019-20, £6.2 billion was spent on agency and bank staff in hospitals in England. The latest figures up to September 2021 show that agency and bank spending has increased still further. Projections show that it is expected to go on increasing next year and the year after. That spend can be reduced if we have a proper long-term workforce plan, which must be underpinned and verified by the provisions set out in Amendment 80.
Let us have the numbers that enable the health and care system to plan properly for the long term. Let us in turn have numbers of staff that we need, carrying out the roles that we need, in the locations where they are needed. Let us reduce the excessive reliance on expensive temporary cover and, in turn, let us generate cost savings that can be ploughed back into high-quality care. Rarely has the phrase “strength in numbers” been more apt.
In moving Amendment 80, I look forward to the debate in your Lordships’ House and to my noble friend the Minister’s reply. I hope he will recognise the strength of feeling in the House and in this country as a whole. If the amendment is not acceptable, I am afraid that I will be forced to test the opinion of the House. I beg to move.

Baroness Brinton: My Lords, I shall speak shortly to Amendment 168, but want briefly to refer to Amendment 80, moved by the noble Baroness, Lady Cumberlege, and so eloquently introduced by her, and supported across the House. Workforce planning is critical. Frankly, it is surprising that Ministers resisted amendments in Committee which called for formal long-term workforce planning for the NHS, social care and public health to be embedded in legislation.
The noble Baroness said that that current arrangements can be a bit like sticking plasters, and she is right, but it is not just about the use of bank and agency staff but about planning healthcare professional education.  We all know how long it takes to train a doctor, but most of the other professionals also cannot just be turned on and off at election time. There have been too many times when this Government have said at elections that they would suddenly magic thousands of extra doctors and nurses. We need to build timescales into that workforce planning. The noble Baroness also talked about population demand, but I want to make another point: this is not just about population numbers; it is also about demographics. We will need more GPs and hospital professionals managing our rapidly ageing population. If we do not encourage people to go into those specialisms, we will not be able to look after our population in 10, 15 or 20 years’ time.
I also agree with the noble Baroness, Lady Cumberlege, that if government resistance is because of the funding implications with delivering such a plan, that is very short sighted. Not planning will be even more catastrophic. Amendment 80 is more modest in nature but is a critical minimum to achieve a commitment to plan effectively for the NHS, social care and public health.
I turn now to Amendment 168. Given that there are a number of speakers on this important group, I will be very brief here too. The amendment from the noble Lord, Lord Hunt, echoes the one he laid in Committee, and I am pleased to have signed both. We heard in Committee about this frustrating loophole that meant that it was not possible for certain members of the Royal College of Physicians of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Emergency Medicine to be added to the list of colleges which could be involved in the appointment of NHS consultants. This is now slowing down the appointment of NHS consultants. I am very pleased to support the amendment and hope the Minister will be able to give good news to the House on this amendment too.

Baroness Pitkeathley: Now I invite the noble Baroness, Lady Masham, who is also speaking remotely, to speak.

Baroness Masham of Ilton: My Lords, I speak to Amendments 80 and 168. Amendment 80 is very important and I thank the noble Baroness, Lady Cumberlege, for being so persistent. Throughout the country there is a workforce shortage in hospitals, the community and social care. At Second Reading, the noble Baroness, Lady Harding, warned that:
“Unless expressly required to do so, government will not be honest about the mismatch between the supply and demand of healthcare workers.”—[Official Report, 7/12/21; col. 1814.]
This amendment would give an independently verified assessment of the workforce numbers to meet the growing needs of the population.
Patients who have serious, rare and specialised conditions such as Guillain-Barré syndrome, spinal injuries and all sorts of conditions need expert, specialised staff and equipment so they get the treatment they need. Otherwise, their conditions can deteriorate and result in added costs to the NHS and the taxpayer. Delayed treatment also means unnecessary pain and suffering for the patients. I hope the Government realise the need for Amendment 80.
I was surprised when I received a letter from the Royal College of Surgeons of Edinburgh telling me that, along with the Royal College of Emergency Medicine, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Physicians of Edinburgh, it was excluded by omission from participating in the process of helping trusts in England recruit much-needed consultants. I wonder what the reason for this extraordinary discrimination is. Does England think it is superior? These royal colleges have been contacted by multiple trusts in England seeking help to recruit the necessary surgeons but, unless this regulation is corrected, they cannot help in this process. This sharing of important selection is more important than ever at this difficult time.
The royal colleges of medicine in Scotland have a good reputation worldwide. I have a personal interest in this amendment, as one of my grandfathers trained as a doctor in Glasgow and one of my cousins trained in Edinburgh and is now a professor of microbiology. I hope the Government can rectify this lacuna in the regulations by accepting this amendment.

Lord Mackay of Clashfern: My Lords, I am an honorary fellow of the two Edinburgh colleges and I strongly support this. It seems extraordinary that these very distinguished colleges which, as has been said, have an excellent record over many years in teaching people not only in this country but in many other countries should be excluded from playing a part in these appointments.
I also support Amendment 80 but would like to elaborate on it a little. I think Health Education England was set up, by the Act that we had before, with some degree of contention. It is a system that is supposed to help determine the future for the health service, with fairly elaborate provisions to that effect, as I remember from that Bill.
It is not at all clear to me how this assessment is going to be done. I see it has to be verified independently, in other words somebody independent of the whole system has to assess it for its accuracy. However, if you need Health Education England to do this for the medical professions particularly, why do you not need something similar to deal with the very complicated system of social care? Therefore, I think the whole system requires to be extended to cover something like Health Education England in relation to the whole area that this amendment covers. The Secretary of State sets up some kind of mechanism for report; it has to be a pretty elaborate mechanism if it is going to work. Therefore, I humbly suggest that something like Health Education England is needed to be the basis on which this assessment arises. Then, of course, you have to provide for the independent assessment of whether it was a good assessment originally. I support this amendment, but I think something more elaborate is ultimately required.

Lord Hunt of Kings Heath: My Lords, I will just speak to my Amendments 111 and 168. On Amendment 111, when the noble Baronesses, Lady Brinton and Lady Masham, and the noble and  learned Lord, Lord Mackay, have already put forward the arguments, there is very little for me to say, but the exclusion of the Scottish colleges from the appointment process needs to be rectified. It is an irritant, a hold-up.
In Committee, the noble Lord said that we needed to go through consultation. That was a dreary and negative response. The Scottish colleges have done that. They have consulted and got the support of the Academy of Medical Royal Colleges, NHS Employers and the NHS Confederation. Surely the Minister can just accept this amendment. To simply say that there is no need for it and lots of consultation has to take place is just a ludicrous waste of time and money. This is the time to do it. He should bring an amendment back on Third Reading and be done with it. The noble Lord says that he wants to improve efficiency in the health service. I am afraid I take that with a pinch of salt, because he is just letting officials run riot around him in relation to petty, bureaucratic objections to this change.
Obviously, my other amendment is not major compared to Amendment 80, which is substantial and very important. The noble Baroness, Lady Cumberlege, has really put it forward with great force. Again, I think the noble Lord needs to take a more vigorous approach with the Treasury, because clearly that is where the objection to this is coming from.
My other amendment is about the terrible problem of GP distribution, or the wide variations. I am not going to tempt the noble Baroness, Lady Cumberlege, to come in on the GP issue—but the latest figures, for 31 December 2021, show, for primary care networks in England, the huge variation in the number of GPs. In 24 of the networks, the average list of registered patients for fully qualified full-time equivalent GPs is more than twice the national average. There are five primary care networks where the average is more than three times the national average; these are often in the most deprived areas. No wonder there is an issue of burnout, early retirements and a move to part-time working.
The Government’s response so far is the targeted enhanced recruitment scheme—an incentive for GPs to go into these areas. It is not enough; a much more substantive piece of work is required, and I hope again that the Minister will come forward with a positive response.

Baroness Jones of Moulsecoomb: I shall speak to Amendment 82 in the name of my noble friend Lady Bennett of Manor Castle. I attended Second Reading and made my views felt then, but I have not been able to join the deliberations on the Bill since then because of the pressure of other Bills in your Lordships’ House.
Even I, as someone who does not know very much about medicine, know that the most urgent challenge currently facing our health service is a shortage of nurses. I have been lobbied very heavily by the Royal College of Nursing, because Amendment 82 is its number one priority. It feels that, without a co-ordinated work plan, a coherent forward view and knowledge of exactly how the situation is at the moment, it cannot possibly achieve the sorts of numbers that are needed. There were almost 50,000 vacancies before Covid, and  you can imagine the pressure that Covid has put on to the NHS—extreme pressure at completely unsustainable levels, and with staff numbers that are actually unsafe. We all know this, yet Boris Johnson and the Conservatives made big promises at the last election—their manifesto made a promise of 50,000 more nurses—and instantly that number began to unravel, as it included existing nurses who do not quit. That is unclever and unsophisticated number crunching.
I do not understand why this Government will not live up to their manifesto commitments. One reason why I have not been able to speak on this Bill since Second Reading is because of all the other Bills coming through, on which the Conservatives have said that they are aiming to achieve their manifesto commitments. They are actually going rather beyond their manifesto commitments in lots of areas—but the fact is that they are picking and choosing as if from a box of sweets the ones that they prefer.
The Royal College of Nursing represents over 480,000 nurses in health and social care. These are people whose pay requests are constantly ignored—and who constantly have their pay cut; in real terms, it has reduced. Just at the point when MPs are getting very welcome extra pay, nurses hang on by their fingertips. We know that vacancies are also a huge problem, with retirement age approaching for a lot of nurses. Nurses need the certainty of planning, and I do not hear those plans coming from the Government, although this is really their job—to manage the economy and manage society in a way that benefits everybody. Clearly, if the NHS fails in any area, that does not benefit anybody at all.
I argue very strongly for Amendment 82, and I just hope that the Government wake up in time to see how necessary it is.

Lord Stevens of Birmingham: My Lords, I am very pleased to co-sponsor the amendment proposed by the noble Baroness, Lady Cumberlege, Amendment 80, and to speak in support of a number of the other amendments in this group. I declare my honorary fellowship of the Royal College of Physicians and the Royal College of GPs, and thank them and the 100 other organisations across the health and social care sector that have joined in the cross-party support that this amendment is likely to generate.
In considering how to vote on this amendment, I think it really boils down to two very straightforward questions. First, do we need regular, rigorous and independent workforce planning for health, social care and public health? The social care point, as the noble and learned Lord, Lord Mackay of Clashfern, has just reminded us, is so crucial here. The second question is: if so, will we get it, with appropriate rigour and independence, without this amendment? I suggest that the answer to that question is, unfortunately, no.
The first question is self-evident to most people. We discussed it throughout Committee: workforce pressures mean that it is obvious that we need regular workforce planning. The very long lead times make it critical. Earlier this week, your Lordships were debating pressures in young people’s mental health services and eating disorder services. It is worth reminding ourselves that a new consultant psychiatrist specialising in eating  disorders, starting work in NHS mental health services this morning, will have entered medical school 15 years ago. It is worth reminding ourselves, too, at a time when the NHS is confronting long waits for routine operations and needs to deal with a backlog of care, that the new medical student starting undergraduate medicine in September will report for duty as a consultant orthopaedic surgeon in 2037.
So the lead times are clear, yet we have a paradox: more young people and, indeed, mid-career people, would like to join this great campaign, this social movement—the health service, social care and public health—but we are turning them away. In 1945, Nye Bevan said:
“This island is made mainly of coal and surrounded by fish. Only an organising genius could produce a shortage of coal and fish at the same time.”
I suggest that, if Bevan were recasting his aphorism for today, he would say that, at a time when the NHS and social care have such a clear need for more staff, only a workforce planning system of organisational genius could turn away bright and committed young people from undergraduate medicine and other oversubscribed university places for health and other professions.
We have to accept that there will be extra costs from getting this right. The noble Baroness, Lady Cumberlege, was quite right to draw attention to the fact that there will be savings, including from the £6.2 billion spent in 2019-20 on agency and bank staffing across the health service. But there will be extra costs: the Royal College of Physicians has estimated that doubling undergraduate medicine places would cost perhaps £1.85 billion, which is about one-seventh of the amount that the House of Commons Public Accounts Committee identified last week as being likely to be lost from fraud and waste through the various furlough and other schemes introduced during Covid. So I think we need to put these costs in perspective.
The fact that there will be those costs gives us the answer to our second question. Of course, we need workforce planning, but are we going to get it without this amendment? I am afraid that I do not think we are. In Committee—although I shall not rehearse it—using publicly available materials, I set out the sorry history of what I described as the “wilful blindness” that has been inflicted on the health and social care sector and, indeed, on health Ministers and the Department of Health and Social Care itself, as they have sought to go about this task down the years.
The question before your Lordships is: has the leopard changed its spots? I suspect—and I genuinely sympathise with the Minister’s predicament—that he will tell us that the baton has now been passed from the Department of Health and Social Care to NHS England, so that for the first time it has the responsibility for undertaking this task, and we should be reassured by that fact. In that case, I ask him to give clear guarantees at the Dispatch Box that the proposed new powers of direction for the Secretary of State will never be used to veto or censor any independent estimates that NHS England itself puts forward, including those with a financial consequence. Indeed, I ask that he goes further than that and gives us a Dispatch Box  guarantee that NHS England will be entirely free to publish, every two years, without approval, veto or censorship from either the Department of Health or the Treasury, the workforce need, demand and supply models implied in Amendment 80. If those guarantees are not forthcoming from the Dispatch Box, I think your Lordships will be entitled to draw your own conclusions.

Lord Hunt of Kings Heath: My Lords, would the noble Lord be surprised to hear the rumours that the Treasury has prevented the Minister from responding in a positive way to this amendment?

Lord Stevens of Birmingham: We await insight from the Minister himself on that point; it is indeed, of course, what the chairman of the cross-party Health and Social Care Committee, Jeremy Hunt, suggested in the House of Commons. We have an immediate litmus test before us, which should help us answer the question posed by the noble Lord, Lord Hunt. As your Lordships will remember, we noted in Committee the fact that, just 10 weeks before the start of the financial year, when it should have been planning 10 years out, Health Education England still did not have its operating budget for the year ahead. My understanding—I hope to be corrected by the Minister—is that, certainly, as of 10 am, Health Education England still does not have its workforce operating budget for just 29 days’ time. That is precisely because of a set of behind-the-scenes discussions—no doubt courteous, but nevertheless fervent—between the Department of Health and Social Care on the one hand and the Treasury on the other.
Health Ministers are more sinned against than sinning on this, frankly, and in that sense this amendment will strengthen their hand. I suspect that, privately, they will welcome the mobilisation of your Lordships to support their negotiating case. The very fact that Her Majesty’s Government oppose this amendment is proof positive that it is needed. We need it because we need to look beyond the end of our noses. To vote against this amendment would be to cut off our noses to spite our faces.

Baroness Whitaker: My Lords, this whole group is worthy of government action, and I support Amendments 80 and 81 in respect of speech and language therapists. The NHS Long Term Plan itself states that speech and language therapists are a profession in short supply. The Department of Health and Social Care, in its submission to the Migration Advisory Committee’s review of the shortage occupation lists, argues that speech and language therapists should be added to them because of the pressures facing these professions, particularly in relation to mental health.
The Royal College of Speech and Language Therapists, for whose advice I am grateful, suggests that a minimum increase in the skilled workforce is required in the region of 15%. In recent years, the profession has grown by 1.7% in a year. The Government themselves recognise that they are clearly not delivering the speech and language therapy workforce that we need. No national assessment has been undertaken of the demand  and the unmet need for speech and language therapy, which, I remind noble Lords, is essential for people to be able to communicate. Will the Government accept Amendments 80 and 81 or explain otherwise how they plan to improve workforce planning so that speech and language therapy is no longer a profession in too short supply?

Baroness Tyler of Enfield: My Lords, I will be exceptionally brief and make two very quick points, but first I need to apologise for, when I spoke earlier, omitting to mention my registered interest as a non-executive director of the Royal Free London NHS Foundation Trust.
I very strongly support Amendment 80, moved so ably by the noble Baroness, Lady Cumberlege, and pressed so very cogently by the noble Lord, Lord Stevens, and others. It is absolutely fundamental to everything that the Bill is designed to achieve, and we will not achieve those things unless the workforce is addressed.
In relation to Amendment 111 in the name of the noble Lord, Lord Hunt, I say that it is so important that we have a review into the distribution of GPs in England. I was very concerned when we debated in Committee the huge variation in list numbers in different parts of the country. The biggest lists were in the most deprived areas. If you track that back to the debate we were having on health inequalities, where there was a huge consensus across the House, it is clear that we are never going to fundamentally tackle health inequalities unless we have far greater equality in things like the size of GPs’ lists.

Baroness Harding of Winscombe: My Lords, I also support my noble friend Lady Cumberlege and Amendment 80. The noble Lord, Lord Stevens, made two points: I would just like to add a third to his argument. He argued that workforce planning needs to happen. There is no large employer of people that does not plan its workforce other than the NHS. We need to do it, and I do not think anyone in this Chamber is going to disagree. He also said that this would not happen without legislation. I will not repeat the points I made at Second Reading or in Committee, or those that he just made so eloquently.
My third point, which I would like to add, is very much addressed to my noble friend the Minister. It is that this amendment will not bring the downsize that the Treasury truly fears. This is actually an amendment of sound management that enables the NHS to manage finances and people better. While there will be more money spent on training, this is actually the way to control the costs of the ever-growing demand for health and social care. If you do not plan, you cannot control the costs. This is actually the way to do the very thing that the Treasury is most concerned about.
Far from locking in old, established ways of working, this is also the way to drive transformation because, unless we are honest about the ever-growing demand for clinicians of every profession, we will not face the fact that we will need to change the way those clinicians work together as medicine and science evolve and all of us age. This is a way to deliver the very thing that the Treasury most wants: control of the finances and transformation of our healthcare services.
With that, I add one final point, and I hope noble Lords will forgive me for repeating what I said in Committee. There is another reason why we need to do this now. Our NHS people are exhausted, and they have lost hope that we understand what it is really like on the ground for them. By passing this amendment, we will give them hope; we will show them that, collectively and cross-party, we really understand that it is they who make our wonderful, precious health and care system work, and we are committed to helping them going forward.

Baroness Finlay of Llandaff: My Lords, I must declare my interests: I am a fellow of the Royal College of Physicians, the Royal College of General Practitioners, the Academy of Medical Sciences, and the Royal College of Physicians of Edinburgh, which is affected by Amendment 168. I am an honorary fellow of the Royal College of Emergency Medicine, president of the Chartered Society of Physiotherapy and an observer on the Medical Schools Council. All those organisations have a vested interest in this amendment.
Very simply, this amendment just makes sense for the future. Without it, the cost of healthcare to the nation will rack up and never come under control. The talk about people working in the NHS is a fallacy. What matters is whole-time equivalents and the competencies of those people with whole-time equivalents. While it is absolutely right to say that it might take 15 years for somebody to come through training as a specialist, what is not understood is that, as soon as people qualify, having left their undergraduate training, they are then on the job. They are learning on the job, working incredibly hard and contributing, but they do not have the competencies developed. That is what takes a long time. The modern techniques that get things done much more quickly and that deal with more patients—laparoscopic surgery having been an example—are highly skilled, but highly efficient.
We have a shortage of 1,400 anaesthetists. Without anaesthetists, you cannot have good maternity services, you cannot operate and you cannot have good emergency services. They are absolutely essential to the whole running of secondary care. Then, of course, in primary care, we have the gaps as well, so the specialist training is really important.
As well as that, this cannot be handed over to algorithms on a computer and left to IT, because of the need for personal interaction between the clinician and the patient and their family. I do not believe that this will be replaced by AI. However, many jobs performed currently will be taken over by AI, freeing up clinicians to become even more specialist competent.
Building on the comments of the noble Baroness, Lady Harding, I remind the House that poor care overall is more expensive than good care in the long term. It is a very short-term view to think that you can provide poor care; in the long term, you really do stack up debt. Stopping workforce planning will not avoid costs at all; all it will do is move the costs from one year further into the future and create bigger problems. Although I hesitate to say it, I think it will also fuel the whole litigation culture.
Amendment 80 is absolutely essential. If it is accepted by the Government, or passed by this House, then Amendments 81 and 82 would fit very neatly into the criteria against which such reports are to be written on the workforce. I remind noble Lords who might be unaware of this that the royal colleges already collect workforce data. Verification of data collected from integrated care boards and areas will not be difficult, because you will simply see how the figures match up. The figures will be reported centrally, and planning can take place. The amendment of the noble Lord, Lord Hunt, is so straightforward; I cannot see why we want to rack up costs further by not putting it through. Vacant posts cost money, they do not save money. By putting that through, we will have more efficient appointment procedures. This is an historical anomaly which could be corrected easily.
Relying on bank staff is really dangerous. Mistakes happen much more often when staff come in who do not know the place, the team or who to call. You would never field a sports team consisting of a bunch of people brought together to play at a high level who had never played before. Yet, what we are doing in our NHS is bringing in bank staff who often do not know the hospital or the team. They do not know the strengths of the other people in the team, so they do not know to whom they can delegate. I hope that the House will approve Amendment 80 if the Government are too short-sighted to just accept it.

Lord Bradley: My Lords, I rise briefly to support very strongly Amendments 80, 81 and others in the group. They have already been explained eloquently, so I will not repeat those arguments. I declare my interest as an honorary fellow of the Royal College of Speech and Language Therapists. We have already heard about their importance, as a profession, as part of the wider allied health professionals. It is always worth remembering that allied health professionals make up a third of the total workforce.
Responding to workforce planning in Committee, the Minister stated that he shares the view of the noble Baroness, Lady Finlay—from whom we have just heard—on the importance of
“integrated workforce planning across NHS and non-NHS employers … and that work is under way on it.”—[Official Report, 24/01/22; col. 102.]
Unfortunately, at that time the Minister did not set out what that work was. The response did not really give a great deal of hope regarding the long-term failings in workforce planning for allied health professionals in general and speech and language therapists in particular. We need to ensure that this is addressed. As we have heard, these amendments properly address the issue.
I draw particular attention to subsection (4) of Amendment 80, which clearly states that royal colleges must be consulted in drawing up the report which will be laid before Parliament on
“meeting the workforce needs of the health, social care and public health services in England.”
By that consultation, we should ensure that allied health professionals, and particularly speech and language therapists, are included. These professionals sometimes work directly in the NHS. Often, however, they work  in other health settings and can be employed in those settings by the NHS. They might also work in settings such as education, the criminal justice system and other parts of the social care system, or in independent practice. They should all form part of the consultation to ensure that the plans which come forward on workforce planning are comprehensive in their nature and coverage. Therefore, these amendments are crucial to achieving this objective. I am sure that the Minister will want to give us that same assurance when he responds.

Baroness Watkins of Tavistock: My Lords, I rise briefly to support this group of amendments and to declare my interest as a fellow of the Royal College of Nursing. It is absolutely clear to me that, without the right staff in the right place, you cannot give the right care. This is the situation we are in at the moment, and we must get it right for the future. We are on an improvement trajectory, and there is an increase in the number of nurses employed in the NHS. However, this is not universal across all areas of the NHS, particularly in learning disability and mental health.
If we could get the Government to support Amendment 80, we could resolve the issue through guidance. On Amendment 81, I also speak for my noble friend Lord Patel, who unfortunately cannot be here today and who believes that an elegant solution as described by my noble friend Baroness Finlay, in terms of guidance subsuming Amendment 82 in particular, would enable directors of nursing, medicine and care to be responsible for ensuring that they have a safe staffing structure in the areas for which they commission care. That would be reported up every two years through the Secretary of State, rather than every five years, as indicated in Amendment 82. This would be a much more suitable solution.

Lord Lansley: My Lords, I will intervene. I was not intending to speak but I was prompted by a recollection arising from the reference to anaesthetists by the noble Baroness, Lady Finlay. I recall that the Centre for Workforce Intelligence produced in February 2015 a report on the future supply and demand of anaesthetists and the intensive care medicine workforce. I have just checked the report, and it projects for 2033 that the number of full-time equivalent staff required will be 11,800, and supply will be 8,000. Therefore, in February 2015, we knew of this set of projections produced by the CWI. It said, among other things, that there should be
“a further review in the next two to three years.”
However, the CWI was abolished in 2016 and its functions were restored, I think, to the Department of Health.
The noble Lord, Lord Stevens, did not refer to this directly, but we must bear in mind the general presumption that there has never been workforce planning, although in certain respects, there has. The report on anaesthetists is only one of a whole string of reports—I could list them, but I do not need to—produced by the Centre for Workforce Intelligence before it was abolished. Their main purpose was to say to Health Education England, “This is the level of education and training  commissioning you should be undertaking in the years ahead”. As the noble Lord said in Committee, it did produce a set of proposals; it is just that they were not acted upon.
I just say this: legislation may be the right way to proceed now, but let us not lose sight of what is actually required, which is for Health Education England not to have its budget cut, as happened in 2016, but to have its budget increased and for that budget to be turned into an education and training commissioning programme that delivers the numbers of trained professionals in this country that we project we will need. It is no good saying, “Oh, we’ve never had planning; we passed a piece of legislation.” I am sorry, it could be a case of legislate and forget unless the money is provided and the commissioning happens. There have been organisations whose job it was to do it—Health Education England, the Centre for Workforce Intelligence—but they were not supported, and in one case, abolished.

Lord Warner: My Lords, I support Amendment 111 in the name of the noble Lord, Lord Hunt, to which I have added my name, and Amendment 80 in the name of the noble Baroness, Lady Cumberlege. On Amendment 111, I want to emphasise two points. First, GPs are and have always been the gatekeepers to the NHS. Without GPs, there is less primary care and less access to the NHS. Over 90% of patients access the NHS through their GPs and primary care. If you are unlucky enough to live in an area with a serious shortage of GPs, your access to NHS services is highly likely to be diminished and your health put at greater risk.
My second point is that it follows that a shortage of GPs is also likely to contribute to health inequalities, a topic much discussed during the passage of the Bill. In addition, this is likely to mean that you live in a place which the Government say they want to level up. So, if the Minister accepts the amendment of the noble Lord, Lord Hunt, he will be helping to deliver two government objectives: reducing health inequalities and levelling up. What’s not to like? Who knows—he might even get a promotion out of it.
I turn briefly to Amendment 80, which I support and will vote for if the noble Baroness pushes it to a vote. I want, however, to emphasise two points that follow on a great deal from what the noble Lord, Lord Lansley, said. For too long the NHS has relied on buttressing its inadequate system for training home-grown staff by recruiting from abroad. Brexit and tighter immigration policies have significantly reduced this supply line. It will take long-term planning and consistency of purpose over many years to rectify the health and care workforce supply problems.
My second and last related point on workforce is that the track record of the Department of Health on long-term planning is appalling. It is not just me saying that; it was made absolutely clear in the report by this House’s Select Committee on the Long-term Sustainability of the NHS and Adult Social Care, so ably chaired by the noble Lord, Lord Patel, who unfortunately, as we all know, is laid low by Covid. Those who support Amendment 80 should hear the arguments in the debate on Amendment 112, which  would support its implementation. The noble and learned Lord, Lord Mackay, thought that something more elaborate than Amendment 80 was required. That may be the case, particularly for social care, but Amendments 80 and 112 complement each other. They are not rivals or alternatives; they put in place a structure thoroughly independent of government and which requires the Government then to pay attention to what has been independently provided.

Baroness Fraser of Craigmaddie: My Lords, it is clear that there remain huge and serious concerns across the House and beyond regarding how the Bill addresses the chronic staff shortages in our health and care services. I say health and care services, because as we know, the staff shortages affecting the delivery of services are not just within the NHS but felt across the board, in health, care and public health services. While this is a current and urgent issue, future workforce planning will be the single most important factor in limiting our ability to deliver the ambitions we all have for the future of health and social care and importantly, the ambitions of the Bill.
Like many other noble Lords, I have the greatest respect for my noble friend Lady Cumberlege, and if she feels that the current duties the Bill places on the Secretary of State in Clause 35 to report at least every five years are inadequate, then I urge the Government to take note. As my noble friend said when she introduced her amendment, she is not alone: at least another 100 organisations are calling for this aspect of the Bill to be strengthened. I ask the Minister today, therefore: if the Government are not planning to accept the amendment, how do they plan to address the challenges of future workforce? How will they assess the future needs of health, social care and public health services? Previous work has not quantified the workforce numbers needed and we cannot wait for another review.
I have a couple of observations on the amendment itself, which I commend in that it does require the Secretary of State to report on this wider health, social care and public health workforce, unlike the current Clause 35, which refers only to the health service. However, I sound a note of caution, because if we simply assess vacancy rates, or get into the mindset of needing to replace like for like, role and service development, which will be essential to support future health and care services as they evolve, risk being stifled, as my noble friend Lady Harding referred to.
Those who hold much of the data on health and care professionals are not only the royal colleges, as the noble Baroness, Lady Finlay, mentioned, but also the regulators. I note that proposed new subsection (4) of the amendment does not mention health and care regulators, which I think should be consulted, in the spirit of my noble friend’s explanatory statement.
Finally, when describing the system in place for assessing and meeting workforce needs, as training and regulation are UK-wide, I hope there will be a spirit of co-operation between NHS England and the devolved nations to ensure that we are training the right people for the right roles across the UK NHS: this needs to be in any future workforce assessment as well. I also cannot understand why we do not accept that the royal colleges in Glasgow and Edinburgh can  help us recruit. That seems completely bananas—that is the technical term. Will the Government accept that we cannot put workforce planning yet again into the “too difficult” box? We need to do more and go further, as my noble friend Lady Cumberlege urges. I accept there are no silver bullets, but the regular publication of independently verified projections of future demand and supply of workforce could, over time, create a sustainable model for improvement that would have a positive impact on both patient care and staff experience.

Baroness Walmsley: My Lords, I congratulate the noble Baroness, Lady Cumberlege, on the way she introduced Amendment 80—it was masterful. I point out that she took this amendment from the right honourable Jeremy Hunt, who unfortunately failed to get it through the House of Commons. In doing so, he expressed his regret that, when he was Secretary of State, he was not able to put in place a structure such as the noble Baroness proposes today.
The noble Lord, Lord Stevens, and the noble Baroness, Lady Harding, have both commented that it is self-evident that we need a workforce adequate to meet the demand. To do that, we need to anticipate increasing demand, changes in demographics, population growth and changes in practice. Crucially, we need to put in place resilience to health shocks. If we do not do that, we will continue to struggle to reach the OECD average of 3.7 doctors per 1,000 people, which is reasonable. To get there, we actually need 50,000 more doctors.
However, as the noble Baroness, Lady Jones, pointed out, this is not just about doctors. It is also about nurses and, as we have heard from the noble Lord, Lord Bradley, and the noble Baroness, Lady Whitaker, it is about allied health professionals. We need to train them all in a timely way, given, as the noble Lord, Lord Stevens, pointed out, how long it takes to train all these health professionals.
The Prime Minister claimed in the House of Commons recently that we have 45,000 more people working in the health service than before the pandemic. Unusually, that may be true, but it was not clear whether they were full-time professionals. However, that number bears no relation to the demand. There is no point in quoting raw figures if they are not related to the rise in demand. Moreover, there are fewer GPs than before the pandemic, and that is where people’s access to the NHS begins. If someone cannot get to see a GP, they cannot get a diagnosis or a referral, and their disease gets harder and more expensive to treat. Having too few GPs is not a cost-effective strategy, so I support Amendment 111, tabled by the noble Lord, Lord Hunt, and also his Amendment 168.
Having too few staff means more staff leaving the service because of stress and burn-out and the realisation that staffing levels are too low to be safe for patients or staff. Staff also know that even before the pandemic bed occupancy levels were too high to allow for the resilience we need in the system, and so they leave.
The amendment also refers to social care staff and public health staff. On social care, a couple of weeks ago we talked in this Chamber about ambulance response  times, and noble Lords all know that the reason why ambulances are too slow to go to patients is that they have to stand outside A&E because they cannot move their patients into A&E. A&E cannot move patients into the main hospital, and the main hospital cannot move its patients into social care because there are not enough staff and placements to give appropriate social care. That is why it is very important that the amendment covers social care staff too. The pandemic has shown us how important public health staff are. That is why that reference is there.
We know that this amendment alone will not solve the staff shortage, but without it we will never reach safe staffing levels. We will continue to have disruptive and expensive staff turnover, we will fail to reach OECD average numbers and we will certainly never tackle the backlog of procedures built up during the pandemic. For health and care staffing to be sustainable, we need a rolling plan of needs assessment and training. Without an independent assessment of the need, how can anybody possibly plan for the health and care staff that we need? It is just not possible.
As the subject of nurses has been so powerfully addressed by the noble Baroness, Lady Jones, I shall also say something about that. I believe that Amendment 80 will serve nurses just as well as it will serve doctors and all allied health professionals. We on these will focus our votes on Amendment 80 in the hope that the noble Baroness, Lady Jones, is reassured and will not feel the need to move Amendment 82.

Baroness Merron: This powerful debate has focused on two simple truths. First, without the full team of people in place at the right time, it will not be possible to provide the health, social care and public health services we need. The second simple truth is that this will not just happen on its own. I am therefore glad to have put my name to Amendment 80, joining the noble Baronesses, Lady Cumberlege and Lady Brinton, and the noble Lord, Lord Stevens, in so doing. I thank the noble Baroness, Lady Cumberlege, for her impactful introduction of the amendment. I share the view of the noble Baroness, Lady Walmsley, that this is the amendment to focus on, the one that will take us in the direction we need to go.
It is hardly surprising that the need for workforce planning has come up time and again during the passage of the Bill, and it is not going away. Workforce planning is at the core of all the plans, yet it remains unresolved and continues to cause considerable disquiet, including in the Health and Social Care Select Committee. We know this is an urgent requirement to tackle, and I hope that, even at this late stage, good sense will prevail and the Minister will be able to give the assurances that your Lordships’ House seeks.
The lack of sufficient staff, trained and able to deliver care, is the biggest issue facing the NHS and social care. Whatever claims are made about how many staff there are, they are meaningless unless posed against what is actually required. Since the Bill was published there has been universal opposition to the limited and inadequate provision in Clause 35. As my noble friend Lord Hunt noted, the Treasury’s robust resistance to publishing anything that sets out  properly the gap between the number of staff required and of those in post is a badly kept secret. I regard that as short-sighted for all the reasons that have come up in the debate thus far.
It is reported that a record number of 400 members of staff are quitting the NHS every week. The United Kingdom has 50,000 fewer doctors than we need, and there are currently 100,000 vacancies. Workforce planning needs to be in place to give us the chance to assess and tackle the workforce crisis. Today we have the opportunity to put that right. As we have heard, the amendment is supported by a major coalition of some 100 health and care organisations. As my noble friend Lord Bradley said, it also takes strength from giving the opportunity to consult a comprehensive range of organisations and groups that know the reality of what is needed to run our care services. We should add our support to that.
I am grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Patel, for adding their support to my Amendment 81. It tackles the same problem, but from the bottom up. Without the foundation of a workforce plan, no ICB can plan anything properly, as they are required to do by other parts of the Bill. There is also the wider point that the national strategies or definitions of systems planning have no reality unless they transfer down to those who actually have to deliver the outcomes. We know that there are widespread and well-evidenced arguments in support of workforce planning. I urge the Minister to accept the wisdom and the reality of these amendments and to take the opportunity to fix a challenge that surely is not going away.

Lord Kamall: My Lords, I am grateful to noble Lords for bringing the discussion of workforce planning before the House today. Perhaps before I go further, all noble Lords will want to join me in wishing the noble Lord, Lord Patel, a speedy recovery. He definitely would have spoken in this debate if he had been able to join us. I should also say that I was particularly impressed by the double act of the noble Lords, Lord Hunt and Lord Stevens. Perhaps they will be known in future as the Morecambe and Wise of the House of Lords.
We all agree that the workforce is at the heart of our NHS and social care. It is right to ensure that we have the workforce that we need for the future to keep delivering world-class, safe and effective healthcare. Some noble Lords may not like to hear this, but I remind them that we have a record number of nurses. We continue to look at different ways of recruitment, and in response to Oral Questions I have referred to the way that we are looking at different pathways into nursing for British people. It is also a fact that we have always recruited people from overseas. Indeed, our public services were saved, post-war, by people from the Commonwealth coming to work in public services. I remind noble Lords that now we have left the EU we will no longer give priority to mostly white Europeans over mostly non-white non-Europeans. We will focus on ensuring that we have equality across the world.
I will not repeat what I have said about other issues, but if you are to have workforce growth, which we all want, it must be accompanied by effective, long-term  workforce planning. That is why the department has commissioned Health Education England to work with partners to develop a robust, long-term strategic framework for the health and regulated social care workforce for the next 15 years. This includes regulated professionals working in adult social care, such as nurses and occupational therapists, for the first time.

Lord Warner: I am sorry to interrupt the Minister but when I listened to that last statement about Health Education England, I wondered whether he had seen the article in the Economist of 5 February, which shows that the guaranteed forward funding of Health Education England extended to less than a month ahead.

Lord Kamall: I am grateful to the noble Lord because that was a point I was hoping to come to when I lost my line. The budget will be agreed by the start of the new financial year and, as in all previous years, following the outcome of the 2021 spending review, spending plans for individual budgets in 2022-23 to 2024-25 inclusive will be subjected to a detailed financial planning exercise, and it will be finalised in time. We have also commissioned NHS England to develop that long-term workforce strategy and the key conclusions from this work will be set out.
Clause 35 will increase the transparency and accountability of the workforce planning process. Noble Lords referred to Her Majesty’s Treasury. The department is working closely with the Treasury to deliver a bigger and better NHS and social care workforce. The spending review 2021 provides a further £23 billion for the NHS for April 2022 to March 2025 and gives a three-year settlement. It will keep building a bigger and better-trained workforce.
Noble Lords also referred to agency staff. The flexible staffing policy aims to provide sufficient temporary staff to the NHS to meet fluctuations in demand. In 2015 the Secretary of State announced the introduction of several measures to reduce the agency spend, including price caps, procurement frameworks and expenditure ceilings. These have contributed to the NHS reducing spending on agency staff by one-third, but we recognise that there is more work to be done. We also recognise that the health and social care workforces are often spoken about separately, and the department is working to integrate the two workforces, as outlined in the integration White Paper. Noble Lords will recall that, in addition, we have started a voluntary register for care staff, which we hope to move to being mandatory in due course, following a consultation to better understand the landscape of the workforce, and to look at different qualifications and make it a better career.
We know that work on long-term workforce planning at a national level will need to be replicated at a local level. Subject to the passage of the Bill, ICBs should be the vehicle to support that. To guide that work, in August 2021 NHS England published draft guidance for ICBs explaining their central role, ensuring that the health and care system has the necessary workforce to meet the needs of the populations it serves. A copy of this guidance has been laid in the House Library. In addition, the amendments on ICBs’ forward plans and  annual reports will require ICBs to report on how they exercise their duty to promote education and training for the current and future workforce.
Amendment 82 refers to safe staffing. The Government are committed to ensuring that we deliver safe patient care and that there are safe staffing levels across the NHS. Safe staffing should remain the responsibility of local clinical and other leaders, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality healthcare is influenced by a far greater range of issues than how many of each staff group are on a shift, even though that is clearly important, and it is why the Government are committed to continuing to grow the workforce.
I now turn to the amendment addressing GP distribution. We fully support the intention, particularly as part of our agenda to level up and recover from the pandemic. However, the pandemic’s impact on the workforce is not yet fully understood and the system is moving to meet the impact in new ways. As a result, a review of GP distribution is likely to be premature but, as noble Lords will recall, we have opened new medical schools in areas where there has been a lack of workforce, in the knowledge that many people stay in the areas where they were trained. That is part of our plan to make sure that there is more equitable distribution. We will also use the targeted enhanced recruitment scheme to incentivise trained doctors to work in hard-to-recruit areas.
On Amendment 168, we will act on the underlying issue of underrepresentation of the royal colleges in the appointment of consultants. My officials are looking to undertake improvements regarding these regulations and what has been said is clearly common sense. Both royal colleges referred to have great reputations; many great surgeons and others have been trained there in the past—indeed, Arthur Conan Doyle studied in Edinburgh. It is important to remember that this is common sense. I assure the House that I am advised that the current regulations do not prevent trusts seeking alternative members to contribute to the consultant appointment process.
I am grateful to everyone who contributed to the debate. I hope I have given some reassurance. I hope noble Lords will recognise that I have engaged with them on a number of different issues in an attempt to close the gaps. I am afraid that, on this issue, I am unable to go much further at this stage. On that basis, I hope—perhaps in vain—that my noble friend will feel able not to press her amendment.

Baroness Cumberlege: My Lords, thank my noble friend very much. He has certainly gone as far as he can today; I am afraid it is not far enough. We have had informal conversations on this and I think it is no surprise to either of us that I was hoping for a great deal more. We have heard 17 speakers and the debate has taken around an hour and a quarter. It has been such an interesting debate—I always learn more in this Chamber, and I learned so much more today.
I want to thank the 17 speakers who have supported my amendment. As far as I can see, not a single one had any reservations about Amendment 80, because it  is so simple. It is not groundbreaking; it simply wants a plan that people can recognise, and one that will fill the gaps in the workforce requirements according to demography and the needs of our population. The amendment is simple and clear, and it will make such a difference, not only to those working in the NHS but to the public, whom we are here to serve.
I thank all those who have taken part, particularly from my own Benches, and all the other noble Lords. I have to say, with some regret, that I have not heard anything that counters the arguments put forward. I was hoping that after Committee we might have found some common ground, but I sense that we have not. I am disappointed by that, so I seek to test the opinion of the House.
Ayes 171, Noes 119.

Amendment 80 agreed.
Amendment 81 not moved.
Amendment 82 not moved.
Consideration on Report adjourned until not before 4.01 pm.

Russia (Sanctions) (EU Exit) (Amendment) (No. 2) Regulations 2022
 - Motion to Approve

Lord Ahmad of Wimbledon: Moved by Lord Ahmad of Wimbledon
That the Regulations laid before the House on 28 February be approved.
Relevant documents: 31st Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.

Lord Ahmad of Wimbledon: My Lords, these two statutory instruments were laid before the House on Monday 28 February 2022 under the powers provided by the Sanctions and Anti-Money Laundering Act 2018, also known as the sanctions Act, and came into effect on 1 March.
We have announced the largest and most severe package of economic sanctions ever in response to Putin’s premeditated and barbaric invasion. Working with our allies, we will continue to ratchet up the pressure. We have already imposed sanctions on President Putin, Foreign Minister Lavrov, five Russian banks, 120 businesses and a long list of oligarchs. Taken  together, they target assets worth hundreds of billions of pounds. Importantly, we have also worked with our allies on this issue, agreeing to remove selected Russian banks from SWIFT and to target the Russian central bank, but we will go further.
We continue to stand with the Ukrainian people in their heroic efforts to face up to unbridled aggression. As I have said on a number of occasions, and as has been said by my right honourable friend the Foreign Secretary, nothing is off the table.
To update noble Lords on where we have got to on sanctions, overnight on 28 February we laid two new pieces of legislation on financial and trade measures. The first included a ban on Russian sovereign debt, a prohibition to limit access to sterling and a ban on any Russian company issuing securities or raising finance in the UK. These significantly strengthen our arsenal of sanctions against Russia. This is alongside increased trade measures, including a prohibition on sensitive dual-use items that could be used by the military and banning a further range of critical-industry goods, from high-tech to aircraft.
Sanctions announced by the United Kingdom and our allies are already having an important impact. Central bank interest rates have more than doubled, international businesses are quickly divesting, and the rouble is now trading at roughly a quarter of what it was when Mr Putin took power. That will impact the institutions that prop up Mr Putin and his cronies. We will continue to work with our allies to bring forward further sanctions and press for collective action to reduce western reliance on Russian energy. We will also continue to use every lever at our disposal to support the legitimate Government of Ukraine and, importantly, the Ukrainian people.
This legislation follows the “made affirmative” procedure set out in Section 55(3) of the Sanctions and Anti-Money Laundering Act 2018. These statutory instruments amend the Russia (Sanctions) (EU Exit) Regulations 2019. The powers in them will prevent Russian banks accessing sterling, which is a significant and new measure for the UK. Russian banks clear £146 billion of sterling payments through the UK financial system each year. Without the ability to make these payments in sterling, designated banks will not be able to pay for trade in sterling, invest in the United Kingdom or access UK financial markets. This matches the power the United States already has to prohibit access to the dollar, showing our joint resolve to remove Russia from the global financial and trade system. Around half of Russian trade is denominated in dollars and sterling. We have already used this power to designate Sberbank, the largest Russian bank.
The same statutory instrument prevents the Russian state raising debt here and isolates all Russian companies—of which there are over 3 million—from accessing UK capital markets. This measure goes further than those of our allies, banning all Russian companies from lucrative UK funding. Russian businesses listed in London have a combined market capitalisation of over £450 billion. This includes some of Russia’s largest state-owned enterprises, and the Kremlin is hugely reliant on their tax revenues. Banning them from  raising debt in London will further increase the burden on the Russian state. Global giants such as Gazprom will no longer be able to issue debt or equity in London. In the last seven years, Russian companies have raised over $8 billion on the UK markets. We have put a stop to this.
The Russia (Sanctions) (EU Exit) (Amendment) (No. 3) Regulations 2022 ban exports to Russia across a range of items, including the dual-use list and other goods and technology critical to Russia’s military-industrial complex and its maritime and aviation sectors. The SI also bans a range of technical and financial services related to such items. With this legislation, enacted in alignment with the United States, the European Union and other partners, we will collectively cut off Russia’s high-tech imports. This includes critical, high-end technological equipment such as microelectronics, telecoms, sensors and marine and navigation equipment. It will blunt Russia’s military-industrial and technological capabilities, gradually degrade Russia’s commercial air fleet, and act as a drag on Russia’s economy for years to come. The Department for International Trade and the Treasury will offer advice and guidance to UK businesses that are affected.
In conclusion, Russia’s invasion of Ukraine is part of a long-term strategy. If we were to give ground now, Mr Putin’s strategy of aggression would never end. Instead, he would be emboldened, and his focus would simply move on to the next target. The United Kingdom has been at the forefront of this response. Importantly, we are acting in concert with our allies; collectively, our measures will deliver a devastating blow to Russia’s economy and military for years to come. The importance of co-ordinating with our partners will allow our sanctions to reverberate through Mr Putin’s regime.
We must remain firm and resolute in our response. We must rise to this moment and, importantly, continue to stand with Ukraine and its people. I am determined that we will continue to support them in that choice. I beg to move.

Lord McDonald of Salford: My Lords, I congratulate the Government on what they have done so far, but does the Minister agree that this package has already been overtaken? It is already inadequate against the developing need. For example, the Germans have been able to impound the yacht belonging to Mr Usmanov in Hamburg, yet he still has access to his stately home in Guildford. How can that be?

Baroness McIntosh of Pickering: My Lords, I congratulate my noble friend on all his efforts and those of Ministers in his and in other departments in both places. However, there is a concern in the country that the inevitable delay in passing the legislation which came into effect on 1 March has perhaps meant that a number of assets have been able to be moved. Are the Government concerned about this?
Looking at SI No.194—I hope I have identified it correctly—I understand that provision will be made for medicines and humanitarian aid to reach Ukraine. I want to press my noble friend as to what routes will  be used. There are reports that pharmacies in Ukraine are already facing a shortage of medicines. There will need to safe routes in.
We can only imagine the level of injuries and casualties that are having to be dealt with at this time. Is there any way in which some of the casualties can be evacuated to neighbouring countries? Is it the Government’s desire to send teams of medically qualified people out from the United Kingdom to assist with this humanitarian effort?

Baroness Wheatcroft: My Lords, I congratulate the Government on having gone further and faster than they had originally planned once the gravity of the situation became clear. Although this may be the largest ever package of sanctions from the UK, can the Minister explain to the House why there are so few individuals on our sanctions list compared with the EU’s? Why, in a particular spirit of generosity, are we allowing 18 months from when the legislation comes into effect for those who wish to sell their houses and get the proceeds out of the country to do so?

Lord Garnier: My Lords, I agree with the noble Baroness’s last remark. I was on the Joint Committee on the Draft Registration of Overseas Entities Bill, which sat in 2019. Clearly, 18 months is far too long if Clause 3 of the Economic Crime (Transparency and Enforcement) Bill is to have any immediate effect.
Is there any possibility of having a look at the enemy aliens Act of 1914? Of course, this is not an exact parallel, but there may be suitable provisions within that old legislation, which was renewed in 1919 after the end of the First World War. Could my noble friend’s officials perhaps look at this legislation to see if there are any useful provisions which could be modernised and brought forward to be of value nowadays—accepting that the United Kingdom is not “at war” with Russia?
While the measures which my noble friend has just announced are hugely valuable, there are three groups of people on whom we need to apply pressure, given that the Ukrainians are actuarily unlikely to win a fighting war, brave as they are and incredible as their resistance has been so far.
First, when the ordinary Russian public are queuing for bread in Moscow because the Russian economy has collapsed, they will begin to wonder why and they will begin to ask why Russian state television and other state-controlled media operations have been less than candid about why the Russian army has gone into Ukraine, its level of success and the number of their children who have been killed. I understand that the Russian army moves, when it can, not just with armoured vehicles, artillery and infantry but with mobile crematoriums, so that the soldiers who are killed are immediately disposed of and the Russian public do not get to know about the huge numbers who have been killed.
Secondly, these measures are partly directed towards the oligarchs and the banking system. I understand that the current sanctions have so far caused about $630 billion in foreign currency reserves and about  80% of the Russian banking sector to be disconnected from the United States financial system. I dare say that there will be similar, if not quite so large, consequences for Russians holding money in this jurisdiction. That is good, but there must be plenty more that we could do. Indeed, the European Union has a longer list of targets than we do, and I urge the Government to increase the number of our targets at least to the level of the EU’s. The rouble is in freefall but, despite all these sanctions, we must remember that North Korea, Iran and Syria, despite being sanctioned at various times, still seem to be operating, even if not happily, under their respective and utterly unattractive Governments.
The third group upon which we need to apply pressure, whether directly or indirectly, is the inner and outer circles within the Kremlin. Once they lose faith in Putin—they have plenty of reasons to do so, and these reasons will grow—his position as the modern dictator of Russia will become even weaker than it currently is.
So, there are three groups that I ask the Government to think about, some of whom can be attacked through sanctions, and some through a media and information war; and some can be influenced by the collapse of the Russian economy. As I said, the Ukrainians will not win a fighting war, despite their very best efforts—and I salute everything they are doing to save their country—but we can help them extra-militarily through applying acute and constant pressure on the three groups I have outlined.

Lord Austin of Dudley: My Lords, I congratulate the Minister and the Government on the tough regime of sanctions that has been introduced this week, and I agree with every word of the previous speech.
This is an extraordinary time. Civilians are being bombed and war crimes are being committed, and extraordinary times require special and extraordinary responses. Ministers are completely right to say that one of the ways to isolate a weakened Putin and to put him under pressure is to target him and his supporters and the money they have stolen from the impoverished people of Russia. As the Foreign Secretary has said, we should sanction Russian government Ministers, senior officials, Putin’s inner circle, the oligarchs who look after his funds, members of the parliament and senior members of the security services and armed forces.
We in this country have a particular responsibility, because so much of the money looted from the people of Russia has been spent and invested here in London. The way to identify the funds, the properties that such people have bought and the businesses they have invested in is to target those who enable them to spend and invest these funds. Just as accountants are required to report clients they suspect of tax evasion, so other businesses and professionals should be required to report people they suspect of benefiting from Putin’s regime. We should make it a legal requirement for lawyers, accountants, company formation agencies, financial services firms, investment companies and estate agents to report on the structures and holdings set up to allow sanctioned individuals to hold assets in this country. Surely, this would make the whole sanctions  process swifter, simpler and more straightforward. Will the Minister look at including measures such as this in the sanctions Bill being brought forward in the next few days?
Secondly, is it true, as Politico reported this morning, that during the rollover of EU sanctions rules into British law during the Brexit process, the UK sanctions regime became significantly more procedurally complex because the new laws were amended to ensure procedural fairness for those being sanctioned, to strengthen measures those sanctions could take in response, and to ensure that sanctions were imposed in what was described at the time as a “proportionate manner”? If it is the case that these changes made the imposition of sanctions more complicated and difficult here in the UK than in the EU or the US, should we not use the legislation that the Minister is bringing forward to unravel these changes so that we can speed these processes up?
Thirdly, is it also the case, as reported in this morning’s Times, that the Government are finding it difficult—despite the work the Minister is doing, which I applaud, and the work of his officials, who I know are working flat out on this—to impose sanctions swiftly because of a shortage of lawyers and officials able to carry out the work? If so, what plans do Ministers have to recruit more people urgently to do this?
Finally, what happens to funds and property and other assets that are frozen or seized from people in this process? I suggest that they be held in trust to support the future democratic Government of a free Ukraine, to rebuild their economy.

Baroness Kramer: My Lords, I raise again with the Government the issue of cryptocurrencies. Effectively, Russians cannot now transfer roubles into dollars, euros and pounds sterling but they can transfer into cryptocurrency. The Minister will know that the Ukrainian Minister of Finance on Monday called on all the decentralised finance—the DeFi exchanges—to remove Russia from their schemes. Some, such as Coinbase, have done so, but others—Binance is the big one that comes to mind—have decided to sanction only the 100 names on the sanctions list and otherwise to allow free translation of roubles into cryptocurrency. We have heard from the Ukrainian Government that this is a serious mechanism for evading sanctions. Binance, which I mentioned, is registered in the Cayman Islands and therefore falls into the UK financial family. What more will the Minister do to prevent what may have looked like a loophole from becoming what is now growing into—a major escape hole?

Viscount Waverley: My Lords, these are dark days. I am delighted to follow and identify with the initial remarks of the noble and learned Lord, Lord Garnier, and the noble Lord, Lord Austin. Our hearts are with the brave people of Ukraine. The Russian people will suffer long-term hardship but nothing compared to that befalling the extraordinary people of Ukraine.
It is no fault of the Russian people that they have no understanding of the reality of why they are being fully penalised. It is quite astounding that, from my calls to Russia, their perception of what is going on in Ukraine borders, frankly, on the fanciful. Disinformation  is rife. These measures are very necessary and the UK Government are doing exactly what they have to do. They have my full support.

Lord Clarke of Nottingham: My Lords, I fully support these sanctions and I congratulate the Government on the packages brought forward. I look forward with interest to the replies to be given to several of the detailed points raised about exactly how firmly they will be enforced.
I will look forward a little. The medium to long-term reality is that we are applying these sanctions against Russia, but Russia is almost certain in the end to achieve some degree of military success. A new reality will dawn, probably with a puppet Government in Ukraine, and the whole issue will start fading from international debate, from the media and so on. What are the Government’s plans for the medium term and, if necessary, the longer-term future in sustaining these sanctions and this level of pressure on the Russian regime?
In reality, there will be quite rapidly a tendency to put pressure on the Government to allow people to return to a new normality: to allow Russian companies to have access to the City of London again and to ease sanctions causing financial losses to lawyers, accountants and firms here. Is the Minister able to assure me that, as far as the British Government are concerned, we intend to retain this degree of sanctions until some satisfactory solution to the political problem is achieved, with a genuine agreement with a respectable Ukrainian Government who have proper regard to international law and national sovereignty? Will the British Government remain one of the more robust in the western lands? There will be considerable pressure to stop doing so much once we have, as it were, done our best to protect the Ukrainian regime during the conflict.
The sooner we start addressing that problem, the sooner we will start facing up to realistic problems that we must plan for. The Russians will undoubtedly, for example, try to ensure that the sanctions do quite a bit of damage to western economies, and will start trying to use their influence on the oil and energy markets to demonstrate that they can cause us some continuing loss unless we begin to lose interest—shall we say?—in the crisis that has so shocked the world. Are we determined to be one of those western countries that will seek to maintain the fullest force of sanctions we can unless and until a satisfactory solution is reached with the Russian regime?

Lord Fox: My Lords, it is a pleasure to follow the noble and learned Lord, who has just given the Government some wise advice which I hope the Minister will carry back to his colleagues.
We welcome the sanctions and look forward to the arrival of the economic crime Bill when it comes from the Commons the week after next. That has flushed out quite a lot of advice and some very strong comments from people who have been looking at the area of economic crime and kleptocracy in this country. One of the threads coming through, which goes back to the issue of what we can do now to stem that flight of capital, is that we are not fully using the anti-money  laundering laws that we already have on statute in order to do that now. Will the Minister agree that more can be done with current legislation, which can be used to help stem the flow of money stolen from the people of Russia? Does he undertake to redouble efforts with all the bodies that have the power to use these anti-money laundering laws to get on and do it?

Lord Purvis of Tweed: My Lords, I welcome these measures on behalf of these Benches and I thank the Minister for maintaining contact and giving advance notice.
These are both the culmination of weeks of lobbying from Parliament to have sight of further measures but also, as noted in this short debate—including by the Minister—the start of a process. They are of a differing character, as the noble and learned Lord, Lord Clarke, indicated. Perhaps these are now of a more strategic nature which will be medium and long term, and perhaps they will have a different characteristic from the sanctions regime that we have put in place, which is different from what the EU scheme envisaged.
The noble Lord, Lord Austin of Dudley, rightly raised a number of weeks ago with the noble Baroness, Lady Williams, in the Home Office, why, as my noble friend Lord Fox indicated, we had not been using existing legislation. It has been highlighted for a number of months that the weak point in the global efforts against money laundering and kleptocracy is in fact the UK. Therefore, questions such as that of the noble Lord, Lord McDonald, are quite right. There is a niggling fear that the UK is still behind the US and the EU in making sure that there is, as the Foreign Secretary said a number of weeks ago, no place to hide for kleptocrats. However, as we have seen, because the Government have now, due to persuasion from Parliament, brought forward the first of the economic crime Bills, there have been, regrettably, plenty of places to hide.
However, we welcome these measures and support them. We have called for wider and further support, including specifically on the point that has been raised consistently and effectively by my noble friend about cryptocurrencies. She raised it with the Ukrainian ambassador when parliamentarians from both Houses met that representative of that extremely brave nation.
We welcome the Government’s additions overnight regarding sterling trade, but can the Minister outline whether we can expand them further to include UK trading houses that operate in denominations other than sterling? London is the centre of many key sectors—energy and specifically gold—where we are leading the world. I understand that beyond the sanctions regime there are landlords in London who are now exiting agreements, for example, with Gazprom Marketing & Trading Ltd. There are voluntary exits of tenancy agreements that are beyond the sanctions regime, but within the scope of very considerable reputational risk. As the SIs indicate, if fully enforced, this represents only 12% of UK exports to Russia. In many areas, the nearly 90% of private sector activity will have the biggest impact. A lot of decisions are being made because of reputational risk.
Regarding loopholes, it is still a concern that the UK has what they consider to be world-leading firms in what is euphemistically called risk management. Many have recruited, to put it politely, former colleagues of the noble Lord, Lord McDonald, and those from within slightly murkier areas of the British intelligence communities. However, there is a trade in second passports, at the moment. The UK can act very firmly with our Commonwealth friends to ensure that those who are potentially in scope of the sanctions cannot quickly secure second passports and utilise others. It is the sanctions regime for not only trade and finance but ministries of justice around the world, and for the Home Office and passport-issuing agencies. There is merit in saying that, if we are now asking questions about where the source of wealth is, there should be questions about why people are seeking second passports, especially in British Overseas Territories and within our Commonwealth family.
In speaking to me earlier, my noble friend Lord Fox referred to kleptocratic capital flight. We will give the economic crime Bill a fair wind and work with the Government in expediting its scrutiny, but we will want it to be tough. It will not have the effect that we want it to have if it cannot be implemented. The noble Lord, Lord Sharpe of Epsom, said in a letter to my noble friend Lady Northover in January that the sanctions unit in the Government has between 40 and 49 staff. That is insufficient for the task that is now ahead of us. Therefore, looking at the capacity and ensuring it is better co-ordinated will be essential.
Regarding other areas of avoidance and enablers, I agree with my noble friend Lady Northover that giving people a legal grace period is not insufficient. I hope that the Government will consider Liberal Democrat proposals to ensure that the new measures can be retrospective to the time of the Bill’s introduction, and that they give fair hearing to the proposal of a clause to ensure that there will be no risk of that legislation being avoided. I hope the Government will give that fair hearing and use other elements such as that indicated by President Biden in his state of the union address—legal mechanisms for seizure. My right honourable friend Ed Davey MP indicated to the Prime Minister over a week ago that we should be serving notice that assets would be seized.
Finally, if the noble and learned Lord, Lord Clarke, is right—and I think he will be—that this will be medium to long term, there will be both other countries negatively affected by this global sanctions regime, especially developing countries, and countries that will be the source of alternative supplies for those we are sanctioning, especially of minerals and technologies. We all know and have debated at length the passive position of India, China and the UAE in the United Nations. Countries that should be in our minds are both those that are alternative sources for Russia, which we are sanctioning, and, as I raised during Questions earlier, those that through no fault of their own face negative impacts from the higher prices of energy and wheat.
To prevent the slow and steady creep back to normality the Government could act by publishing risk registers of those who they believe will be in scope and disclosing  publicly those who are lobbying against these measures, or indeed, lobbying for them to be delayed. Full transparency will be the enemy of those seeking to avoid these measures, in many respects. I hope the Government will consider actions to prevent that kind of flight, which we all know is regrettably happening now.

Lord Collins of Highbury: My Lords, I too fully welcome the introduction of these sanctions. The Government will have our full support in holding Putin and his acolytes to account. I believe—and I said this earlier to the noble Lord—that the noble and learned Lord, Lord Clarke, is right; these sanctions are about not only how effective they will be, but how sustainable they will be. We need to focus on their sustainability as much as their effectiveness.
I reiterate the promise of the shadow Minister for Europe, my honourable friend Stephen Doughty, that we will work with the Government at speed to pass any necessary legislation to this effect. Russia’s invasion is an act of barbarism which requires a united response from all who value the principles of sovereignty and democracy, which must include measures to exclude it from the benefits of the global financial system.
Reflecting all contributions from noble Lords today, our only ask is that the Government go further and faster. I said this morning in Oral Questions that one of the problems with the strategy of ratcheting up is that there is an element of forewarning, which obviously has an effect. In the areas of asset freezing of Russian banks and oligarchs, there is a serious risk of asset flight. The noble Lord, Lord McDonald, mentioned this point very effectively. I asked the Minister this morning whether there has been any preliminary assessment of whether this has already happened. That is one of the things in terms of preparation. Like other noble Lords, we welcome the new legislation to set up a register of overseas entities holding UK property, but the decision, as noble Lords have pointed out, to delay its introduction for 18 months clearly allows oligarchs to escape sanctions.
I also mentioned to the Minister earlier that Labour’s Front Bench on the legislation in the House of Commons has tabled measures to require the new register to come into force within 28 days of the legislation passing. I hope that the Government accept this amendment. It is important that we remain united, as I have said before, as a Parliament and a country.
The steps taken to cut Russia out of the western economic system are particularly welcome, and the efforts on SWIFT and the Government’s push to get a global response to that has been really important. It has been well known that Russia has been developing alternatives to SWIFT since calls first emerged for Russia’s exclusion during the invasion of Crimea. I hope that the Minister can update the House on what assessment the Government have made of Russia’s potential for developing an alternative, again picking up a point made by the noble and learned Lord, Lord Clarke, about the sustainability of our actions.
Given that not all Russian banks are currently included, the Government are right to call for an expansion. Has the FCDO had any recent high-level  conversations about that? The Government should also consider how they can widen the number of banks that are prevented from accessing sterling and expand sectoral sanctions. The Minister mentioned those, but we should even be thinking of the insurance market. There are other areas and the noble and learned Lord, Lord Garnier, was right to focus on the interest groups that may have the most influence on Putin and his acolytes. I agree with the points he made. One not insignificant idea on export controls is to look at the luxury goods going into Russia. We know that cars are included, but there is a whole other range. That visibility could address the point made by the noble and learned Lord about soft power and how we raise awareness in Russian people’s minds about the impact of their Government’s action.
The designation of further individuals was highlighted by the noble Lord, Lord McDonald, and the point was raised on Radio 4’s “Today” programme. The Prime Minister suggested that more than 100 further persons could now be sanctioned. It is clearly now possible that those with links to the Kremlin will use that as a warning to sell their assets. We have seen that the Chelsea owner, Roman Abramovich, is seeking to offload the club, with a price tag believed to be £3 billion. His multimillion-pound residential properties are also up for sale. He says that proceeds will be donated to good causes, but the truth is that we will never know where that money will ultimately end up. Does the Minister believe that Mr Abramovich’s actions have been driven, at least in part, by the Prime Minister’s incorrect assertion that he was on the UK sanctions list? Do the Government agree that any form of pre-notification, or indeed inclusion of grace periods for certain banks, severely undermines the effectiveness of sanctions? I have heard the Minister repeatedly say in the Chamber in the past that he will not indicate or respond about future designations because it does precisely that.
We need to return to the point about how fast we designate people. When the Government extend their designations—I hope that will be soon—I hope that they will allow parliamentarians to suggest further targets. We had this debate about the mechanisms for informing the Government and the FCDO about possible targets when we debated the sanctions Bill. That intelligence may go beyond normal intelligence service facilities, but we should be open to those sorts of suggestions.
Finally, we must all remember that Russia is supported by Belarus and treat Lukashenko’s regime as belligerent. The sanctions announced against individuals in Belarus are a step in the right direction, but we should consider other options for deterring their involvement. Do the Government plan to match the measures announced by the EU for banning machinery exports to Belarus? As the noble and learned Lord, Lord Clarke, said, it is misguided to think that we have time on our side. For as long as the Kremlin continues this campaign of violence, we must hold to account all those who enable it. We welcome these sanctions but look forward to further measures being brought forward on a speedy basis.

Lord Ahmad of Wimbledon: My Lords, I thank all noble Lords for their strong support for the sanctions more broadly and specifically for the measures that we are debating today. I say from the outset that I agree totally with the noble Lord, Lord Fox. Existing laws and processes should be fully leveraged to ensure that those actions that have been taken can be fully applied rather than our just waiting for new legislation to pass. The noble Lord, Lord Austin, and others, pointed to the importance of resourcing. I assure him that it is at the forefront of our thinking, both in the context of the FCDO and across government, including the Home Office.
I am grateful to all noble Lords who have contributed on the specific sanctions before us, but as I expected—it is no surprise to anyone—our discussion this afternoon has gone much wider. I am sure that will be reflective of the upcoming debates both on the legislation and on specific issues relating to the unravelling of the situation in Ukraine.
The noble Lord, Lord McDonald—I nearly said “noble friend”; he was certainly a friend when he was a PUS—will know all too well that I cannot comment on specific designations. Nevertheless, I hear what he says. In this regard, I assure him and all in your Lordships’ House that we are aligning ourselves. Where there are designations which are reflective of partners who may have moved forward more quickly or broadly, we are working closely with them. Questions are often asked about our alignment particularly with the EU. Noble Lords may be aware that my right honourable friend the Foreign Secretary has been invited, along with representatives of the United States, to attend the European Union Foreign Affairs Council to ensure that we are fully aligned in how we move forward, both in the governance structures and in the specific designations. That underlines the challenge that we face but also, importantly, the collaboration and collective response from the Government of the United Kingdom and Governments of key partners, including those within the European Union. My right honourable friend the Foreign Secretary is visiting key partners today as I speak.
The measures that we have taken are already having a significant impact, but I assure noble Lords that I have listened carefully to and made note of their suggestions as to what more we can do in consultation with our allies. As we debate legislation which enables what action we can take, further announcements will be made. The noble Lord, Lord Collins, talked about Belarus. We will debate the specific application of those sanctions in the coming days. We will introduce further sanctions and prohibitions on financial services relating to foreign reserves exchange and asset management by the Russian central bank. These too will be before us in the coming days.
My noble friend Lady McIntosh rightly talked about ensuring humanitarian carve-outs from our sanctions. From our experience in Afghanistan, I have been very minded to ensure that this is part and parcel not just of our thinking but of our processes. My engagement earlier this week in Geneva with key  partners working on the ground, including the various agencies of the UN but also the likes of the ICRC, was focused on the very issue that she highlighted.
The United Kingdom has also said that we will work with our allies in NATO. On Friday, NATO leaders reiterated their commitment to Article 5 in solidarity and support for Ukraine, which many noble Lords mentioned. We will also provide further humanitarian support, which has been announced by my right honourable friend the Prime Minister. The UK has also announced £100 million of new funding to aid efforts to build Ukraine’s resilience and reduce reliance on Russian energy supplies. I listened very carefully to the noble Lord, Lord Austin, about particular assets held and how they are best utilised. Past conflicts have also demonstrated the legal challenges that apply, depending on who owns what assets and the legitimacy of the Government of a given country to have a right to those assets. We can talk of conflicts past, on which we are still trying to unravel some of those issues. I am sure that noble Lords welcome the additional £100 million of new funding from the United Kingdom to build Ukraine’s resilience and reduce reliance on other areas, including energy and security.
My noble and learned friend Lord Garnier rightly highlighted the different groups. Again, that is very much part and parcel of our thinking on how we can target further work and co-ordination with our key partners. I am also minded very much to agree with him on the important issue of Russian disinformation. The Russian Government are conducting an aggressive set of information operations against Ukraine and NATO in a shameful attempt to justify action against Ukraine. I have to say to my noble and learned friend that I think we all take encouragement that the protests against Russia’s actions are not limited to countries outside Russia. We have certainly seen disgraceful scenes today of protests being again put down in St Petersburg by Russian military and security forces, but they show that the Russian people totally despise the actions being taken by President Putin, and we will work to see how we can strengthen our influence through soft power.
Whoever we target under designation criteria will remain subject to a test of appropriateness, as set out under the sanctions Act. I have made this point before: our values and our system acknowledges that we have a robust legal framework to our sanctions, and we will need to consider carefully how sanctioning individuals helps to achieve the purposes of the regime. The whole essence—and I say this as the UK’s Human Rights Minister—is very important to me in the fairness that we apply when we look at such issues. However, equally, we are very much committed as a champion of freedom and democracy to tackle corruption and illicit finance that directly undermine security and democracy. The UK will use our autonomous sanctions and other tools to send the clearest possible message that the UK is not a safe haven for illicit wealth or financial flows, including those from Russia.
The noble Baroness, Lady Kramer, rightly raised the issue of cryptocurrencies, which are not so specific to the current instrument, but crypto-assets are economic resources and are therefore covered by the UK’s financial sanctions. I believe that with the economic crime Bill  and other measures that will be taken there will be broader discussions about that issue. The noble Baroness is totally right that where we identify the so-called loopholes that have been used creatively, to put it that way, by those seeking to avoid particular rules, regulations and sanctions, we need to close them down as quickly as possible, but in conjunction with our partners and allies.
My noble friend Lady Wheatcroft raised the issue of property. My understanding is that properties subject to asset freezes are not directly seized, but they cannot be sold and employees cannot work in those properties. She raised the issue of the 18-month figure, which I think is very much within the provisions of the economic crime Bill that has been introduced. If I may, I shall write detailing the specifics. There are qualifications within that, but she is right to raise the issue. As I say, I am sure that it will come up in the debates we have on the Bill.
My noble and learned friend Lord Garnier also raised the issue of EU comparisons. As I have already said, we are working together closely. Where we are perhaps ahead or behind any of our key partners we are looking to align as quickly as possible on specific steps that we are taking.
On the issue raised by my noble and learned friend Lord Clarke, he may not remember, but I remember as a much younger man listening to one of his speeches in a think tank. We were discussing Iraq at that time. My noble and learned friend articulated very clearly—and his views have come to pass—that an intervention in Iraq would not resolve the conflict, as some of it was embedded in religious differences based on 1,500 years of different perspectives. I agree with him that this is about the long haul. I assure my noble and learned friend that we are absolutely determined that the actions we are taking today will remain robust. The United Kingdom has been playing a leading role in ensuring that as we work with our international partners, particularly those in the European Union, we recognise their challenges and where there are issues, for example with Germany and energy, we make the case powerfully and constructively while recognising that we need to move together.
I say to my noble and learned friend that it will not just be about the resolve of the United Kingdom. This resolve will need to be reflected within the wider international community to ensure we are fully aligned. That is why, in terms of our ministerial engagement, we are speaking extensively with our key partners, not just on a daily basis but on an hourly one. My right honourable friend the Prime Minister, the Foreign Secretary, other Ministers and I are travelling quite extensively. We are taking action, as was shown by the United Nations vote yesterday. We are working with the US, the EU, the G7 and the OSCE. It is good to see how we are working with other key partners and perhaps even with those partners or other countries where we do not see eye to eye and with countries where we have big differences, including China. The fact that China abstained not once but twice—once at the Security Council and then yesterday at the General Assembly—shows that diplomacy and diplomatic efforts are also vital in our response.
I have sought to cover the specifics—

Lord Purvis of Tweed: With regard to China and the position of the UK, as the Minister will know, the UK is a global hub, not only for oil trading but also for shipping and for insurance of that global shipping. Especially with Russia and China, insurance—I think the noble Lord, Lord Collins, referenced insurance, but I did not pick up what the Minister had said about that—for shipping is one of the key elements in doing real harm to the Russian oil and gas sector. A lot of it is brokered through London. Can the Government please outline what they intend to do about this sector?

Lord Ahmad of Wimbledon: My Lords, the specifics of shipping—the noble Lord had also raised wider issues such as bullion—are very much part of our thinking. On shipping specifically, the noble Lord will know that we have already taken the lead. My right honourable friend the Transport Secretary introduced certain measures that restrict the movement of Russian vessels and their landing in UK ports. The noble Lord is right to raise the broader issue of insurance and the hub and the role that the United Kingdom plays. We will be taking further measures in this respect and the details of them will follow.
As I have said throughout this whole process, as these measures are coming in, it is a very fluid situation. We are working as quickly as we can. There is the legislation in front of us that we are approving today—I hope that will be the case—and other measures already under way, some announced and some not. I do not want to pre-empt them. However, the noble Lord is quite right to raise the shipping sector. I hope that the steps specific to that sector that we have already taken indicate the Government’s route in terms of our intention to work further to limit, as the noble Lord says, the effectiveness of Russian activity in that sector.
If there are more specifics, as I said to the noble Baroness, Lady Wheatcroft, I will write specifically on those questions, but I assure noble Lords that we will continue to work very closely both within your Lordships’ House but also beyond. I am particularly grateful to the Front Benches and other noble Lords for their advice and insights, but also, I say, once again, for their strong support for the actions the Government are taking as we stand up to the regime which is now persisting. I use that word quite deliberately. Ministers are often questioned when we waver between the use of “Government” and “regime”. The distinction I would draw is that when the Government of a country seek to suppress their own people in a way that does not allow anyone the right to protest, when a Government seek to eliminate and eradicate the right of a neighbouring country to exist, it is right that we use that different word and call it a regime. That is what Mr Putin’s regime currently is. Its ability to wage war in Ukraine must be disabled.
It is important that we work to ensure that the economic impact is felt by those oligarchs and businesses that support the Russian regime. It is important that we take action but, equally, at the same time, we must send a strong signal to the Russian people that this war, this challenge, the economic war we impose against the Putin regime, is not against them; these are actions  to ensure that we act against Mr Putin and his supporters. We continue to stand by those brave, courageous people in Russia who protest against his actions. Most important is that this House sends a very clear message, as it has done today, that we stand with the people of Ukraine. We will continue to have debates on this specific issue and once again I thank all noble Lords for their strong expressions of unity on the actions the Government are taking in support of Ukraine and the people of Ukraine.
Motion agreed.

Russia (Sanctions) (EU Exit) (Amendment) (No. 3) Regulations 2022
 - Motion to Approve

Lord Ahmad of Wimbledon: Moved by Lord Ahmad of Wimbledon
That the Regulations laid before the House on 28 February be approved.
Relevant documents: 31st Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.
Motion agreed.

Health and Care Bill
 - Report (2nd Day) (Continued)

Clause 39: General power to direct NHS England

Amendment 83

Lord Lansley: Moved by Lord Lansley
83: Clause 39, page 47, line 37, at end insert—“(4) A direction under section 13ZC may not be given in relation to a decision about the relative allocation of resources to integrated care boards.(5) A direction under section 13ZC may not be given in relation to a decision about the results of a procurement of goods or services provided for the purposes of the NHS in England.”

Lord Lansley: My Lords, noble Lords will recall from Committee some substantial discussion about whether it was wise for the Secretary of State to take additional powers of direction in relation to NHS England. I suppose I should declare an interest since I gave the NHS commissioning board, or NHS England, the freedoms it currently enjoys. I am probably the person least likely to be persuaded that it is a very good idea to take all that away. After our debate in Committee, I thought it was probably sensible, rather than to seek to remove the powers of direction that the Secretary of State is given under Clause 39, to look at the exceptions to that power in new Section 13ZD and ask: are these all the exceptions that we should have?
On Amendment 83, the conclusion I reached was that there were at least two specific areas which are not mentioned in new Section 13ZD but should be; namely,  limitations on the use of this power on the part of the Secretary of State. First, the local allocation of resources to integrated care boards—and the difficult decisions of trying to remedy the inequalities in access to healthcare services through the resource allocation process—is not something which any of us want the Secretary of State to interfere with; otherwise, it is sure to be regarded as being done for a political purpose, even if it might be done for another.
Secondly, there is the question of
“procurement of goods or services”.
After all the experience we have had over recent months, the last thing any of us wants is to go too far in the direction of the Secretary of State having a power in relation to procurement when that can perfectly well be given as a responsibility to NHS England. This is Amendment 83, and I hope that my noble friend, if he cannot accept the amendments, will give us some specific assurances in relation to the Secretary of State not using those powers.
In this group, I also put my name to Amendment 84, which would remove Clause 40—and, by extension, Schedule 6—from the Bill. This is about the Secretary of State coming in and acquiring more powers than was formerly the case. I was shadow Secretary of State for six years or so. During that time, I would have loved it if the then Secretary of State had all these powers to intervene in every reconfiguration, because I went around the country—as people are fond of reminding me—mobilising opposition to some of the ways in which the health service, led by the then Government, was trying to reconfigure services. This is not something that the Secretary of State or the current Government should wish for themselves or for their successors in office. I will not go back into all the arguments, but there are plenty of good examples of where, if the Secretary of State had this power, people would press the Secretary of State to use it—and it would be deeply unwise for a Secretary of State to get involved.
The justification on the part of the Government is that it stops this going on for ever. But there is a reason that these things go on for a long time—because they are intensely difficult, and the balances are very difficult to strike. Sometimes, the processes of consultation and public engagement take a long time. If the Government’s argument is that they are going leap in, intervene and settle it all quickly, both sides will yell when they do that. We can be absolutely certain of this. No one will be happy, and everyone will blame the Secretary of State. This is very firmly in the “be careful what you wish for” category. We would do the Government a great service by deleting Clause 40 from the Bill. If the noble Baroness, Lady Thornton, pursues that, I will certainly support her. I beg to move Amendment 83.

Baroness Thornton: With the leave of the House, I thought it might be useful if I used my slot to speak right now on leaving out Clause 40. First, I thank the noble Lords, Lord Patel and Lord Lansley, and the noble Baroness, Lady Walmsley, for putting their names to this amendment. The noble Lord, Lord Patel—with whom I spoke this morning, and who is definitely on the mend, so I hope we will see  him next week—said how strongly he supports the amendment. I will speak very briefly because we have already said much of what needs to be said about saving the Secretary of State from himself—as the noble Lord, Lord Lansley, said, I think. This is what this amendment is about.
Clearly, this is not what the NHS asked for in the Bill. It did not ask for this power. It has been added to the Bill—by a previous Secretary of State, I suspect—and I hear rumours that even the current Secretary of State is not a great fan. Why would any Secretary of State want to have this power—to be lobbied and drawn into any minor local dispute, particularly as we head towards a general election?
I have a small anecdote. A small coastal town had a small hospital with an accident and emergency department. It could not be properly staffed, it regularly closed for random periods, and far too often patients arrived there only to be moved to the larger A&E 20 miles down the road. Proposals were made to close it—and of course, outrage ensued. “Save our A&E”, people said, even though it was unsafe. Local politics were poisonous, and the blame for the closure was thrown on opponents, whichever side they were on.
However, over time, good communications, clinical leadership and, eventually, bringing local people into the team, got the proposal moving. People understood what was needed and why, and the reconfiguration process went through its stages, with external reviews and analysis by the national clinical advisory team, which all gave reassurance. The clincher came when a distinguished clinician leading the review told a meeting that he would personally go and paint over the road signs for the A&E, because it was so unsuitable. It shut, which probably means that lives were saved.
The process of rational argument and proper analysis works, and on this occasion we should not just leave it to local politics to decide what reconfiguration means. The Secretary of State has enough powers to direct the whole NHS in its fullness, but should not be involved in what may be very small reconfigurations indeed. We agree, and many people in the NHS and its organisations agree, that this clause should be removed from the Bill.

Lord Hunt of Kings Heath: My Lords, I have no doubt that when the Minister responds he will say that the Secretary of State is likely to use this power very rarely. The point is that the moment the health service knows the Secretary of State has such a power, that will immediately influence its behaviour in relation to any improvements or major changes of services likely to lead to opposition from the local Member of Parliament. I think that the Minister is responsible for innovation in the health service, and this will put the kibosh on innovation and service changes.
Written on my heart is Kidderminster General Hospital. The Minister may not recall this, because it is a long time ago now, but Worcestershire Health Authority made proposals to reconfigure A&E services and close Kidderminster General Hospital. The then Member of Parliament, David Lock, who was a loyal member of the Government, bravely defended that decision. He lost his seat in 2001, and it has been  written on the hearts of many MPs since then that they do not defend that type of change, because they might lose their seats.
I cannot believe that the Government wish to give the Secretary of State the nightmare of that kind of lobbying—I am trying to tempt the noble and learned Lord, Lord Clarke, to intervene here, because he knows what MPs do. What we have at the moment is a very good system, at arm’s length, and it beats me why on earth the Government want to do this. We need to do the business and get rid of the clause. I suspect that we shall not see it back again.

Baroness Walmsley: My Lords, Amendment 84 is intended to remove the powers of the Secretary of State, in Clause 40, to intervene in decisions on reconfigurations of health services. I said in Committee, and I say again, that those powers are very dangerous. We have recently seen how the Government’s powers to provide or withdraw funding for a proposal to, say, build a new school or improve infrastructure in a particular constituency have got them into trouble. Political considerations have trumped public interest. In the media they call that pork barrel politics—not a very complimentary phrase, I am afraid.
All politicians know that the provision of a new hospital or clinic, or the closing of a healthcare setting or a rural school, are very sensitive considerations in elections. All parties pay close attention to such things at election time and between elections. The Prime Minister knows this—why else would he put such emphasis on the promise of 40 so-called new hospitals by 2030? He knows that it makes a good headline.
The powers of reconfiguration being sought by the Secretary of State in Clause 40 would enable this Government to change the decisions of those put in place locally, who are well qualified to make those decisions in a non-partisan and needs-based way, and thus allow the Government to wield unwarranted political power and take it from the competent people they have put in place to take those decisions. I do not trust this Government, who are currently trying to use the Elections Bill to ensure that they continue in power, to resist using these Secretary of State powers in this Bill for political purposes. It is incumbent on all parties to stop them, and to stop any future Government doing this, by removing Clause 40.

Lord Kamall: I thank noble Lords for bringing this debate to the House today. I am sure that the Secretary of State will be grateful for the desire to save him from himself and his powers. Let me read out the following quote:
“If we went out to Parliament Square now and straw-polled people walking by, asking them who they thought was responsible for the NHS in England at a national level, I think we would wait a very long time before anyone gave any answer other than the Government and, by extension, the Secretary of State”.—[Official Report, Commons, Health and Care Bill Committee, 21/9/21; col. 393.]
These are not my words, but those of the Opposition spokesman during Committee in the other place.
One of the core pillars of the Bill is to ensure appropriate accountability for the NHS. This is of the utmost importance as we invest further in local service decision-making and delivery. It is critical that, in line with the aims of the Bill to empower local systems, the Secretary of State has the appropriate levers to meet the public expectation for ministerial accountability.
There has been some confusion about what the powers in the Bill will do, and if noble Lords will allow me, I will spend a moment on this to add clarity. Clause 39 will simply allow the Secretary of State to direct NHS England—and only NHS England—on matters where it already has functions. This is not a power over local bodies. Clause 40 and Schedule 6 will allow the Secretary of State to call in and decide on reconfiguration decisions. They do not remove any of the existing safeguards, including the requirement to consult or the role of the Independent Reconfigurations Panel in providing advice to the Secretary of State.
I understand the arguments put forward in Amendment 83, and I will take procurement first. We agree that it is inappropriate for the Secretary of State to be involved in individual procurement decisions. That is not the motive behind this power, and it is not the way it would be used. The regulation-making power inserted by Clause 70 prevents the Secretary of State being able to use this direction-making power to direct NHS England—

Baroness Thornton: The Minister said that this was not the motive behind the power, but motive is not the point here. I am sure that the Secretary of State has the best of motives, as does the Minister, but the point is the effect of what the Bill says.

Lord Kamall: I thank the noble Baroness for clarifying that. Of course, we completely understand the concerns that have been raised. The Secretary of State must use regulation-making powers where they exist, rather than using the power of direction to achieve what could be achieved under regulations.
Turning to the allocation of resources to the ICBs, the Government have no ambition to use this power to interfere with individual allocations of money to the system. It will not be used to interfere with the independent Advisory Committee on Resource Allocation. NHS England will continue to make funding allocations to ICBs to support them to deliver functions via the target formula, in order to reduce inequalities between patients. We have attached safeguards to this power to make sure it is not misused. Any exercise of this power must be done transparently: it must be made in writing, be published and be made in the public interest. This will enable Parliament to challenge Ministers and hold them to account.
Turning to Amendment 84, Clause 40 and Schedule 6 will allow the Secretary of State to better support effective change and respond to stakeholder concerns, including views from the public, health oversight and scrutiny committees and parliamentarians, in a more timely way. The clause and schedule will ensure that key decisions made about how services are delivered are subject to democratic oversight.
It is a misapprehension that the Secretary of State currently has no role in the decision-making process for reconfigurations. He does and without these provisions  that role will continue. However, currently, referrals usually come at a very late stage in the process, which represents neither good value for the taxpayer nor good outcomes for patients.
I understand the concerns from noble Lords, including former Ministers, about how these powers might be used. But I have been asked to make clear that we expect the vast majority of reconfiguration decisions to continue to be managed by the local system—

Lord Hunt of Kings Heath: I am sorry to interrupt, but does the Minister not take my point that it is not that Ministers will have to use those powers; it is that they have powers that will change behaviour immediately in the health service? That is the issue.

Baroness Walmsley: Before the Minister answers that question, I wonder if he would be kind enough to answer two from me. He just gave a list of what the powers will not be used for, but could he tell us what sort of thing the powers will be used for and under what circumstances? Can he also say why previous Secretaries of State—some of whom are not very far from where I am standing now—did not feel the need for those powers and still felt themselves accountable for the health service?

Lord Kamall: I thank noble Lords for those interventions. If they will allow me, I will come to answer them in my remarks.
We understand the concerns about how these powers will be used. It is in the interests of nobody, least of all the Secretary of State, to be making every decision in the system, and stakeholders will be encouraged to continue to resolve matters locally where possible. Duties for those responsible for reconfigurations to involve patients and consult the local authority will continue. Nevertheless, the Secretary of State is ultimately accountable for all changes to the health service. Therefore, it is entirely consistent with democratic principles that he or she should have the ability to intervene where it is deemed to be in the interests of the public.
We recognise that, in exercising these powers in this clause and schedule, it will be vital that the Secretary of State receives expert and clinical advice. That is why the Independent Reconfiguration Panel will continue to provide independent advice to the Secretary of State, allowing them to benefit from its many years of experience. This will mean that the Secretary of State will have independent advice that will include the views of both overview and scrutiny committees and patients, and the clinical case for change—

Baroness Cumberlege: I thank my noble friend. On this clinical advice, he is aware of the enormous changes that were made to stroke services in London. In the reconfiguration that took place, many lives were saved. But when it came to east Kent, the reconfiguration request, which was to do with stroke services, sat on the Secretary of State’s desk for two years. I just wonder how many people died for that delay.
When I put forward an amendment in Committee, I said that a decision must be made within three months by the Secretary of State if it is before his view, on his desk.  Delay costs lives. It is absolutely critical that decisions are made fast in these reconfigurations, because we will lose lives.

Lord Kamall: Indeed, sometimes it is absolutely critical that decisions are made quickly. Where there are concerns about the speed of those decisions, the Secretary of State may ultimately decide to intervene, subject to advice from the Independent Reconfiguration Panel, overview and scrutiny committees, and patients, and based on the clinical case, should he or she decide to exercise powers under this clause.
I understand the concerns raised in this House and have heard the arguments presented today and in Committee. However, I think it would help if I reminded noble Lords that the Secretary of State’s powers included in the Bill are to ensure accountability. The public rightly want to hold the Government to account for the health service, and these powers allow that to happen effectively. The other place acknowledged that approach and supported it—

Baroness Walmsley: I cannot believe that the Minister meant to imply that all the structures being set up in this Bill are not accountable, because there are a whole lot of accountability measures in this Bill which will hold to account the people making these decisions without the Secretary of State. One might think from what he just said that the powers are very narrow.
But I draw his attention to page 206 of the Bill. In proposed new Section 68A(4)(3)(a), it just says that the Secretary of State can decide whether a proposal goes through or not, but in proposed new Section 68A(4)(3)(b) it says that the Secretary of State can intervene in the “particular results” that have to be achieved. In proposed new Section 68A(4)(3)(c) he can decide the procedure and other steps that should be taken in relation to the proposal. In proposed new Section 68A(4)(3)(d) there is the
“power to retake any decision previously taken by the NHS commissioning body”.
These seem to be very broad powers; they are not just small intervention powers by the Secretary of State.

Lord Kamall: The noble Baroness raises some important points, but I remind her that, alongside those, she should consider safeguards and limitations that are being put in place to address these concerns and the importance of ensuring due accountability for health service delivery. I understand the strong feeling among noble Lords and have tried to go as far as I can in addressing those concerns. I once again, perhaps in vain, ask noble Lords to think about the assurances that have been given and not to move their amendments when they are reached.

Lord Lansley: My Lords, I am grateful to my noble friend. In particular I am grateful for his specific assurances on the powers of procurement and the question of resource allocation. We can be pretty confident that the Secretary of State would not interfere with the Advisory Committee on Resource Allocation or the NHS England response to it. If the Secretary of State were to start messing with the formula, we would get into a very difficult place.
I am still of the view that there was a very good reason we gave NHS England greater freedoms. I think it would not have been possible for NHS England to have published its Five Year Forward View in 2014 or even more so the Long Term Plan in 2019, in circumstances where it had occupied the same relationship with the Secretary of State as it did in the past.
This is taking NHS England from its current degree of independence to something that it was not in the past, but is a little more ambiguous. It will be difficult, for precisely the reasons the noble Lord, Lord Hunt of Kings Heath, explained, for the NHS to feel that, when the successor to the long-term plan is published by the successor to the noble Lord, Lord Stevens of Birmingham, it is the NHS’s own plan. That has been very important; Ministers have said it a thousand times. Why do we not let that happen? The measures in Clause 39 take a real risk of infringing on the idea that it is the NHS’s own plan.
It does not mean that the Secretary of State is not accountable, but that they are accountable in ways that they can legitimately control: the resource allocation and an expectation of the priorities and outcomes. That is where the Secretary of State should be putting the weight of the Government, not in trying to decide how outcomes in the NHS are best achieved. I do not agree in principle with what is proposed in Clause 39, but I am not going to press that point.
I will, however, if the noble Baroness, Lady Thornton, pushes it, support her on Clause 40. I say to my noble friend: look at Schedule 6. The structure of it does not even mention the Independent Reconfiguration Panel. As soon as there is a proposal for a reconfiguration from any of the NHS bodies, it quite clearly places in the hands of the Secretary of State the responsibility to decide whether to go ahead with it or not. That will be exactly the moment when the Secretary of State is drawn in and is not able to be extricated from it.
My noble friend has simply to look at the example of the reconfiguration of congenital paediatric cardiac services to realise that no sensible Minister would have been drawn into that debate at an early stage with any confidence of being able to make a decision that would have been accepted by any of the parties to that debate.

Lord Stevens of Birmingham: The noble Lord raises the congenital paediatric cardiac case, and the noble Baroness, Lady Cumberlege, raised the Kent stroke question. On that question, the estimate was that 40 to 50 people will have died or lost their ability to live independently as a result of that two-year delay. Is it not the case that, for the very reasons that the noble Lord, Lord Lansley, has just set out, those kinds of delays will now be invisible to the naked eye because these proposals will never get off the ground due to the self-censoring of necessary clinical change that would save lives, precisely as the noble Lord, Lord Hunt of Kings Heath described?

Lord Lansley: We all know that when these proposals come forward, there is a lot of local pressure. In many cases, it will be local pressure that is transmitted to the Secretary of State by Members of Parliament who are—

Baroness Penn: My Lords, it might be worth reminding noble Lords that on Report, noble Lords only speak twice for short questions of elucidation.

Lord Lansley: I am responding to the debate, am I not?

Noble Lords: You are.

Lord Lansley: The noble Lord was elucidating something to which I was responding. That is my view. Anyway, I was not planning to go on at any length. My point is very straightforward. As the noble Lord, Lord Hunt, said, that will be transmitted to the Secretary of State at an early stage, before the point where the Secretary of State can, in any practical way, distance himself or herself from the decision by giving it to the independent reconfiguration panel. There is a process out there. I am a Conservative, and we do not change things that are not broken. This is not yet broken. It is a system that has been used tolerably well and we should stick with it, so I support leaving out Clause 40. However, I beg leave to withdraw Amendment 83.
Amendment 83 withdrawn.
Ayes 145, Noes 122.

Amendment 84 agreed.

  
Clause 45: NHS trusts: wider effect of decisions

Amendments 85 to 87

Lord Kamall: Moved by Lord Kamall
85: Clause 45, page 50, line 6, leave out “The reference in subsection (1)” and insert “In subsection (1)—(a) the reference”Member’s explanatory statementThis amendment is consequential on another amendment which provides that references in new section 26A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.
86: Clause 45, page 50, line 9, at end insert—“(b) the reference to effects of a decision in relation to the health and well-being of the people of England includes a reference to its effects in relation to inequalities between the people of England with respect to their health and well-being;(c) the reference to effects of a decision in relation to the quality of services provided to individuals includes a reference to its effects in relation to inequalities between individuals with respect to the benefits that they can obtain from those services.”Member’s explanatory statementThis amendment provides that references in new section 26A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.
87: After Clause 45, insert the following new Clause—“NHS trusts: duties in relation to climate changeAfter section 26A of the National Health Service Act 2006 (inserted by section 45 of this Act) insert—“26B Duties in relation to climate change etc(1) An NHS trust established under section 25 must, in the exercise of its functions, have regard to the need to—(a) contribute towards compliance with—  (i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.(2) In discharging the duty under this section, NHS trusts must have regard to guidance published by NHS England under section 13ND.””Member’s explanatory statementThe new Clause would require NHS trusts, in exercising their functions, to have regard to certain matters relating to the environment, including climate change.
Amendments 85 to 87 agreed.

  
Clause 54: Capital spending limits for NHS foundation trusts

Amendments 88 to 91

Lord Kamall: Moved by Lord Kamall
88: Clause 54, page 53, line 16, at end insert “in respect of a single financial year”Member’s explanatory statementThis amendment means that any order imposing a limit on the capital expenditure of an NHS foundation trust may only relate to a single financial year (rather than spanning more than one financial year).
89: Clause 54, page 53, line 20, leave out “period” and insert “financial year”Member’s explanatory statementThis amendment is consequential on the amendment requiring an order under new section42B(1) of the National Health Service Act 2006 to relate to a single financial year.
90: Clause 54, page 53, line 22, at end insert—“(4A) An order under this section may be made at any time during or before the financial year to which it relates.”Member’s explanatory statementThis amendment is consequential on the amendment requiring an order imposing a limit on the capital expenditure of a foundation trust to relate to a single financial year. It clarifies that although the limit must relate to the whole financial year, the order imposing it may be made part-way through that year.
91: Clause 54, page 53, line 24, leave out “period” and insert “financial year”Member’s explanatory statementThis amendment is consequential on the amendment requiring an order under new section42B(1) of the National Health Service Act 2006 to relate to a single financial year.
Amendments 88 to 91 agreed.

  
Clause 59: NHS foundation trusts: wider effect of decisions

Amendments 92 to 94

Lord Kamall: Moved by Lord Kamall
92: Clause 59, page 55, line 37, leave out “The reference in subsection (1)” and insert “In subsection (1)—(a) the reference”  Member’s explanatory statementThis amendment is consequential on another amendment which provides that references in new section 63A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.
93: Clause 59, page 55, line 40, at end insert—“(b) the reference to effects of a decision in relation to the health and well-being of the people of England includes a reference to its effects in relation to inequalities between the people of England with respect to their health and well-being;(c) the reference to effects of a decision in relation to the quality of services provided to individuals includes a reference to its effects in relation to inequalities between individuals with respect to the benefits that they can obtain from those services.”Member’s explanatory statementThis amendment provides that references in new section 63A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.
94: After Clause 59, insert the following new Clause—“NHS foundation trusts: duties in relation to climate changeAfter section 63A of the National Health Service Act 2006 (inserted by section 59 of this Act) insert—“63B Duties in relation to climate change etc(1) An NHS foundation trust must, in the exercise of its functions, have regard to the need to—(a) contribute towards compliance with—(i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.(2) In discharging the duty under this section, NHS foundation trusts must have regard to guidance published by NHS England under section 13ND.””Member’s explanatory statementThe new Clause would require NHS foundation trusts, in exercising their functions, to have regard to certain matters relating to the environment, including climate change.
Amendments 92 to 94 agreed.

  
Clause 62: Joint working and delegation arrangements
  

Amendments 95 and 96 not moved.

  
Clause 67: Wider effect of decisions: licensing of health care providers

Amendment 97

Lord Kamall: Moved by Lord Kamall
97: Clause 67, page 61, line 42, at end insert—“(2AA) For the purposes of subsection (2)(da) (as read with subsection (2A))—(a) a reference to the effects of decisions in relation to the health and well-being of the people of England includes a reference to the effects of the decisions in relation to inequalities between the people of England with respect to their health and well-being;  (b) a reference to effects of decisions in relation to the quality of services provided to individuals includes a reference to the effects of the decisions in relation to inequalities between individuals with respect to the benefits that they can obtain from those services.”Member’s explanatory statementThis amendment provides that references in new subsection (2)(da) of section 96 of the Health and Social Care Act 2012 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.
Amendment 97 agreed.

  
Schedule 10: The NHS Payment Scheme

Amendment 98

Lord Lansley: Moved by Lord Lansley
98: Schedule 10, page 223, line 21, at end insert—“(5A) Rules under subsection (1) may not be framed by reference to whether the provider is in the public or, as the case may be, private sector.”

Lord Lansley: My Lords, I will not go on at great length because noble Lords have heard more than sufficient from me today, but this group brings us to what is known in the trade as the provider selection regime: that is, how the NHS goes about the process of commissioning services from a range of providers and the relationship between that and the choice that is available to patients. I am going to refer to my amendments, Amendments 98 and 99, and, without going on about it, I commend Amendment 80 in the name of the noble Lord, Lord Warner. Finding out whether people have actually experienced choice and whether that is helpful to them is a useful thing to do, and I am not sure whether it features in the current electronic referral system. It would be useful to add it in.
The words of Amendment 98 are in fact already in the regulations that the NHS currently lives by because, born of the previous experience when there were discriminatory payment arrangements for private sector providers relative to public sector providers—ie, more advantageous payment arrangements for the private sector than the public sector—in the 2012 legislation we legislated to prevent that happening in the future. The current Bill removes said prohibition on discrimination on the basis of the ownership, public or private ownership, of a provider.
Noble Lords might think, “Ah, this is trying to avoid us discriminating against the private sector.” This was actually included in order to prevent the Government or the NHS discriminating in favour of the private sector. There may be arguments for it in certain circumstances because NHS bodies often have, as it were, fully depreciated assets and to create additional capacity the private sector very often has to invest capital and has to meet the costs of capital as well as the revenue costs of providing services. None the less, we addressed all that and took the view that we did not want any discrimination: we wanted no competition on price, but we wanted competition on quality. That is why, to be perfectly frank, I am testing the Government’s intentions in omitting something that was a central plank of policy for the 2012 legislation.
On Amendment 99, if I recall there is language in the original White Paper from last year, which set the provisions for the Bill, which referred to “any qualified provider” and made it clear that it was the Government’s intention to maintain the existing choice arrangements and access to any qualified provider. Indeed, I think it said that it would “bolster” the system, although I am not sure whether that is happening anywhere. The amendment is really intended to test a particular issue that arose. I am a very sad person, and I was looking at the service conditions for the NHS standard contract; the noble Lord, Lord Stevens of Birmingham, will know them intimately. There is a point at which commissioners who are presented with people who wish to access other providers, who have a contract with another commissioner, are not required to extend that service to them. The way in which it was written in the standard contract was to talk about circumstances where the originating contract does not refer to the address—I think it said the postal address—included in the originating contract. My point to the Government is that this is absurd. There can be geographic limitations, but we should aim not to make them as limiting as the reference to a postal address in the originating contract would have made them.
The wider point is that, if one looks at the new provider selection regime, one sees that there is a process by which commissioners—the decision-making bodies commissioning services—go through a process of saying, “What are the circumstances of commissioning providers?” They ask whether it is circumstance 1, extending the existing arrangement; circumstance 2, going to a different provider; or circumstance 3, going to competition. The language of circumstance 2 is:
“where the decision-making body wants to use a different provider and the decision-making body considers it can identify a suitable provider without running a competitive procurement process”.
This is something that it will be readily able to do in many cases. A commissioner can say, “This is the circumstance. We want to go to a different provider and we know who we want to go to—that’s fine, we’ll give them the contract.”
Circumstance 3 is
“where the decision-making body cannot identify a single provider or group of providers that is most suitable without running a competitive process; or to test the market”.
The body could choose to test the market, but of course more than subtly. Whereas, in the past, the NHS tended to think that it needed to test the market in circumstances in which the legislation did not actually require it to, there is no such thing as compulsory competitive tendering in the 2012 legislation, or the regulations made under it. But now it has shifted completely the other way, and NHS bodies will be able broadly speaking to choose not to use competition at all. The question is whether that will really be sustainable. In the short run, access to the private sector may well be quite widespread, and there may well be a significant element of choice available to patients through the electronic referral service, but that may be closed down in years ahead, if these provisions are implemented in the way in which they are set out.
I issue a further warning to my noble friends. If you are a provider of services to the NHS and you believe that a decision has been made unfairly or inappropriately  by the NHS, there is a standstill on the contract, you have 30 days, and you can send in a complaint, in effect, to the decision-making body, which then decides whether it has done the right thing. There is no independent process whatever, so it seems that the chances of providers resorting to law to challenge what they regard as unfair decisions on the part of decision-making bodies in the NHS rise dramatically with the implementation of these processes.
All that said, I hope what I can hear from my noble friends on the Front Bench is that what they said in the White Paper a year ago in February 2021 remains true: that they are going to sustain patient choice, that they will use the resources of NHS providers and beyond to enable us to fulfil our very demanding recovery programme, that they will think hard about whether the precise language in some of the respects that I have outlined is fair to providers, and that commissioners in the NHS will use their procurement capabilities to deliver best value for patients. I beg to move Amendment 98.

Baroness McIntosh of Hudnall: The noble Baroness, Lady Brinton, is contributing remotely.

Baroness Brinton: My Lords, I start by commending Amendment 100 tabled by the noble Lord, Lord Warner, and I look forward to hearing him speak on it. It is an excellent idea to ask people how much choice they have actually had when offered treatment. I also thank the noble Lord, Lord Lansley, for explaining his two amendments, and I would like to say to him that he is not sad for carrying out his role in your Lordships’ House with interest and care. His expertise in matters that may leave others cold should be celebrated. The amendments of the noble Lord, Lord Hendy, ask that trade unions should be part of consultations on private providers, and that seems sensible.
I wish to focus, albeit briefly, on Amendment 106A, which proposes that Clause 70 be left out, and which will be spoken to later by the noble Baroness, Lady Thornton; I apologise to her that under the remote rules I have to speak first. I will confine my remarks to the views of the Delegated Powers and Regulatory Reform Committee’s 15th report, in which paragraphs 17 and 18 make plain its views about these proposed procurement arrangements and regulations. The first point that it notes is that the memorandum, at paragraph 481, says that
“full analysis has not been completed and there has not been time to produce a more developed proposal.”
Why on earth do the Government wish to bring into force legislation that they admit they have not had time to analyse, let alone produce a more developed proposal for? We from our Benches, along with other noble Lords, have repeatedly said that the Cabinet Office procurement Bill is likely to overtake the needs for NHS-specific procurement regulations.
Paragraph 17 of the DPRRC Report gets straight to the heart of the issue and provides a response to the amendments that the noble Lord, Lord Kamall, has tabled, starting with Amendment 101 in this group. It says:
“We do not accept that the inclusion of regulation-making powers should be a cover for inadequately developed policy.”
It is therefore more than a little surprising to see a slew of government amendments on this issue that, in the group under discussion, strengthen the powers under regulation.
Paragraph 18 of the Delegated Powers Committee report states that:
“Ministers would not ordinarily propose clauses in one Bill possibly requiring imminent amendment in a subsequent Bill without expecting to face questions. The House may wish to seek further and better particulars from the Minister concerning the possible effect of any Cabinet Office procurement Bill on the Health and Care Bill, and … to press the Minister on why it was necessary to include provision, based on inadequately developed policy, in the Health and Care Bill when the Government intend to introduce a procurement Bill.”
Not only have we tried this at an earlier stage, but there have been meetings between Committee and Report, and it appears that the Government are determined to press on. I know that the noble Baroness, Lady Thornton, has concerns about the Government’s intentions on the clause and its amendment; if she chooses to call a Division on stand part, we from these Benches will support her.

Lord Hendy: My Lords, I support Amendments 98A, 98B and 98C. Among other things, the Bill is designed to facilitate the outsourcing to private contractors of NHS services currently carried out in-house. That is the Government’s policy for the NHS, although it is firmly opposed by most of the citizens of this island.
These are topical amendments, since it has been announced today that 1,800 Serco workers will be brought in-house at Barts Hospital and put on NHS terms and conditions. The amendments would protect NHS workers from the consequences of the policy of outsourcing. Usually when public services are outsourced, the contractor makes a profit by reducing the number of staff performing the work formerly done in-house and by cutting staff wages, terms and conditions. The Transfer of Undertakings (Protection of Employment)—TUPE—Regulations mitigate that process but usually only by delaying it. TUPE also fails to protect when contractors subcontract parts of the operation or hire new staff on new terms and conditions.
Amendment 98A would prevent cuts to the wages, terms and conditions of NHS staff who are outsourced and prevent contractors hiring staff on worse terms, thereby undercutting in-house staff. It does so by requiring that the pricing rules for paying contractors must preserve, then and for the future, the going NHS staff rates, terms and conditions, as negotiated from time to time between the NHS unions and NHS Employers. Payment of those prices would be dependent on honouring those terms.
In Committee, the Minister rejected the need to protect NHS staff in this way, saying that the NHS remained committed to Agenda for Change, which is the name given to the current collective agreement, but he further stated:
“Independent providers will remain free to develop and adopt the terms and conditions of employment, including pay, that best help them attract and keep the staff they need”;
in other words, nationally negotiated terms and conditions for NHS staff which have applied since the founding of the NHS are to be abandoned. Those who work in the outsourced parts of the NHS are to be thrown to the wolves.
It is not just national terms and conditions that are to be jettisoned for those NHS staff but their ability to be collectively represented at all. Let us not be in doubt that their terms and conditions will be fixed unilaterally by the new provider on a take it or leave it basis. Their collective voice will be silenced. The Minister acknowledged that when he went on to say:
“However, we expect that good employers would set wage rates that reflected the skills of their staff”;—[Official Report, 26/1/22; col. 402.]
in other words, each employer will set the rates unilaterally in accordance with market forces at the lowest possible level that the staff will tolerate. There will be no trade union representation. Of course, the undercut rates for the outsourced staff will be used to resist higher wages for those lucky enough to be retained in-house. This is a lose-lose situation for the staff, although no doubt the privateers will make their profit. Our NHS, already sustained on cheap labour and the good will of its heroic staff, will become an even greater exploiter of labour. This will be a disaster for patients too.
The fact is that NHS staff are grossly underpaid, and the real value of their wages is falling. After years of pay freeze, last year’s miserable 3% increase is being destroyed by an inflation rate of 6% this year. The inadequacy of their terms and conditions is the prime reason for the extraordinarily high level of vacancies—93,000 at the end of last year—which increases as more work is done by fewer hands. A catastrophe looms.
Briefly, Amendments 98B and 98C are intended to ensure that the unions are among the consultees on the likely impact of payment schemes. I am grateful to the noble Baroness, Lady Brinton, for her support for that proposal. The Minister sees no place for unions in setting the terms and conditions of external providers, so it is even more vital that trade union consultation is made an explicit requirement of the pricing process. This is particularly so given that the providers themselves are to be consulted on the prices they are to be offered—in stark contrast to the workers, under the current draft. I hope the Minister will agree to modify these provisions accordingly.

Lord Warner: My Lords, my Amendment 100 requires NHS England to
“conduct a public survey of whether patients have been offered choices about where they obtain treatment and must report to the Secretary of State what action they will take as a result of the survey.”
I am grateful for the support of the noble Lords, Lord Hunt and Lord Lansley, and the noble Baronesses, Lady Cumberlege and Lady Brinton.
Currently, there is no regular survey of whether patients are aware of their right to choose or of how many have exercised it. The last NHS England official survey of whether patients were aware of their choices was in 2015, when just 47% of those questioned said they were aware.
Waiting times vary enormously by geography. Knowing about the right to choose could mean a significant cut in the waiting time for treatment. For example, waiting  times for orthopaedic care vary from 89 weeks in Bedfordshire Hospitals NHS Foundation Trust to 25 weeks in the relatively nearby Milton Keynes trust. Recent polling by the Royal College of Surgeons showed that 73% of patients questioned would willingly travel to a surgical hub which was not their local hospital if they could be treated more quickly.
There is no system for monitoring whether patient choice is working. Amendment 100 fills this gap and restores the situation to where it was before 2015. I hope the Minister will accept this simple amendment in the interests of patients.

Baroness Jones of Moulsecoomb: My Lords, I am implacably opposed to privatisation of the NHS—not for ideological reasons, although the Green Party is strongly opposed as well. I think it is inefficient. Privatisation has not worked. It has failed to deliver on promises to increase quality, decrease cost and help patients. Rather than save money through reduced bureaucracy, the main cost savings of privatisation seem to be in cutting the terms and conditions—chiefly the pay and pensions—of staff. If private companies can compete for public services, let them compete on a level playing field, rather than simply capturing staff and paying them less.
I am pleased that the noble Lord, Lord Lansley, explained his Amendment 98 because I had understood it completely the other way around—that he was protecting private services. I was going to have a word with him afterwards about it, but there is now no need.
As the noble Lord, Lord Hendy, just said, most people in Britain do not want a privatised NHS. They want a public service because that is what will give them the best results.

Baroness Thornton: My Lords, this group contains a number of helpful amendments. I welcome the amendments that the Government have tabled in response to the many and varied discussions we have had. I am grateful for this positive and constructive approach, which proposes transparency at the heart of procurement.
We have discussed with the Government at some length why the NHS has to have its own bespoke procurement regime, which the Bill paves the way for. We have seen two consultation documents about the scope, scale and nature of this bespoke regime. Although they seem quite sensible, we have been assured that the Government feel that the regulations will be based on a sound foundation.
The noble Lord, Lord Warner, is quite right about patients not knowing their right to choose. It is a hole in the provision. The right to choose is very important. People absolutely do not know that they have it.
While not being explicit, the new providers’ selection regime will actually get us to where Labour tried to get in 2010 with the NHS as the preferred provider, at least as far as the many complex and expensive services provided by NHS trusts, FTs and other core patient-facing services are concerned. Therefore, the principle is fine. The problem is that it does not extend across everything that the NHS procures, and that is partly the nub of what my noble friend said in his amendments, which I will return to in a moment.
Our view is that in any circumstances where competitive procurement is to be used, the national rules apply, so why does the NHS need a bespoke system for all non-clinical stuff? We have never actually had an answer to that, except that the NHS comes up with wider regulations, and we feel that that it is a waste of time and effort. However, we have had ample assurances from the Government that the NHS bespoke regime will be properly documented and all the rules set out, with some route to enforcement and challenge. We are assured that there will be no award of contract without applying the process that is set out—no back doors and no flexibility when contracting with private companies. With those assurances in mind and the knowledge that campaigners and trade unions will be vigilant and might even stump up for judicial review, and because of the ICB amendments agreed earlier in the week, we will get more or less what we wanted and we will not try to remove Clause 70 from the Bill.
I turn to the remarks of my noble friend Lord Hendy, who has our sympathy and approval. Had we been discussing this at a different time of day, we may have sought to support some of his amendments, and certainly the spirit of them. He has posed a legitimate question to the Minister: why do the Government not insist on good employment of staff as a criterion for their procurement regime?
We on this side of the House remain opposed to the outsourcing of NHS-funded services such as cleaning, catering and many others because we can see that it has led to staff being transferred into the private sector, corners being cut and standards dropping. It has been a symptom of chronic underfunding and it is a terrible long-term strategy. It has of course been completely counterproductive because it has sometimes meant that our hospitals have not necessarily been cleaned, serviced or looked after as we might have wished them to be. We have tried at various stages to introduce safeguards and to outlaw altogether the NHS’s tax-dodging habit of setting up SubCos, but those are probably matters for another day.
I would say to my noble friend that I am not sure that changing the procurement regime is the best way forward for this issue, although he has our support in the politics and context in which he introduced his amendments.

Earl Howe: My Lords, before addressing the amendments in the name of my noble friend Lord Lansley and the noble Lords, Lord Hendy and Lord Warner, it may be helpful if I speak to the six government amendments in this group: Amendments 101 to 104, 106 and 107. The first five of these amendments would amend Clause 70, which inserts a new regulation-making power in relation to the procurement of healthcare services, Section 12ZB, into the NHS Act 2006. They amend the clause so that regulations, when they are made under this power, will have to include provision for procurement processes and objectives, for steps to be taken when competitively tendering and for transparency, fairness, verifying compliance and the management of conflicts of interest. Amendment 106 also requires NHS England to issue guidance on the regulations.
It was always our intention for the regulations made under the power inserted by Clause 70 to include these vital aspects of the new provider selection regime. However, we have listened to the concerns of the House and hope that these amendments, alongside the information we have provided through the consultation we launched on 21 February, provide noble Lords with reassurance as to the intended contents of those regulations. Secondly, Amendment 107 makes the regulations subject to the affirmative procedure. We are grateful for the input of the Delegated Powers and Regulatory Reform Committee in advising us on this. In summary, these regulations will allow the NHS to procure healthcare services in a way that reflects the reality of those services without unnecessary bureaucracy and with the ultimate goal of providing value for patients, taxpayers and the population in the vital health services they need.
I respond to the noble Baroness, Lady Brinton, by saying that we intend to remove the procurement of healthcare services from the scope of the Public Contracts Regulations 2015. The future government procurement reforms will not overtake the provider selection regime made under powers in this Bill. Any amendments made as a result of the Cabinet Office regime will be minor ones to ensure alignment between the regimes. The PSR will not be replaced when the Cabinet Office regime come into force.
I turn now to my noble friend Lord Lansley’s Amendment 105, which is aimed at setting some general objectives for procurement. We agree that services should always strive to meet the needs of service users and it is our intention that the regulations made under Clause 70 will set out general objectives to ensure that procurements are carried out in a way which promotes the interests of patients, the taxpayer and the population, and supply the services that patients need.
NHS England consulted in 2021 on proposed key criteria for decision-makers, with agreement or strong agreement from around 80% of respondents that these key criteria were appropriate considerations. These include quality and innovation; value; integration; collaboration and service sustainability; social value; and opportunities to increase access to healthcare, reduce health inequalities and disparities, and promote patient choice. However, decision-makers should have flexibility to weight the criteria according to the needs of their population. I say to my noble friend that including four of these objectives in the Bill risks the appearance of prioritising them above all others, which I am sure is not his intention. He will know the trap that exists in legislation in having a list that is not exclusive.
I hope that my noble friend is also reassured by the government amendments in relation to fairness in procurements. It is intended that this will include applying the regime to different types of provider equally and being able to clearly justify procurement decisions by reference to the objectives and key criteria.
I turn next to Amendment 98. The NHS payment scheme will set rules about how commissioners pay providers for services and will apply to all providers of procurements: that means NHS trusts, foundation trusts, the voluntary sector and the independent sector.  NHS England and NHS Improvement, which set the current tariff, are moving away from payment by activity to a population-based payment model with a mix of fixed and variable payments. Individual prices may still be used for smaller contracts or as the basis for setting fixed or variable payments.
There may be scenarios where it is appropriate to have different pricing rules for individual providers, to take account of cost variations. But I can assure my noble friend that this would not be solely on the basis of whether they were an NHS or an independent provider. When setting any prices, as required in the Bill, NHS England will aim to ensure that the prices payable represent a fair level of pay for the providers of those services, as well as fair pay between providers of similar services.
Turning now to Amendment 98A, I want to restate that the department and NHS England remain committed to Agenda for Change. As part of the process of setting the rules for the payment scheme, NHS England will, of course, want commissioners to consider staff pay, pensions and terms and conditions. Similarly, NHS England will continue to take account of cost growth arising from uplifts to Agenda for Change. Independent providers will remain free to develop and adopt the terms and conditions of employment, including pay. However, we expect that good employers will set wage rates that reflect the skills and experience of their staff.
I turn next to the question of consultation, as mentioned in Amendments 98B and 98C. New Section 114C makes it clear that, before publishing the payment scheme, NHS England must consult any person it thinks appropriate. In practice, we expect this to include trade unions and staff representative bodies such as the Social Partnership Forum, NHS Providers, the Healthcare Financial Management Association and all the royal colleges. NHS England must also provide an impact assessment of the impact of the proposed scheme.
I now turn to Amendments 99 and 100, which are about patient choice. First, I begin with Amendment 100. As a point of principle, we believe in giving people choice, in terms of GPs, elective care and, where possible, personalisation. This Bill builds on and strengthens that principle. I can understand the desire of the noble Lord, Lord Warner, to ensure that patients are offered meaningful choices, but I hope I can reassure him that the mechanisms for this are already in place. NHS Digital already has a patient survey process in place to see whether patients were aware of the choices they could make and were offered those choices. The NHS e-Referral Service tracks referrals to secondary care, which are an indication of where choice has been offered. There is also a national e-RS pop-up survey for patients, which collects data on whether choice has been offered by primary care for elective referrals. Results of the patient survey are published by NHS Digital on a quarterly basis. So this amendment would require NHS England to duplicate functions of an existing process, and I suggest to the noble Lord that that would not be a profitable route to go down.
I move to Amendment 99. My noble friend Lord Lansley has highlighted a part of the standard contract which relates to patient choice. I hope that I  can give him some comfort. Yesterday, NHS England published its response to the consultation on the 2022-23 standard contract. It includes clarifications to ensure that current rules in relation to the legal right of choice of provider are properly applied in situations where the provider does not have a contract with the responsible commissioner of the patient being referred. Where providers are able to offer new, clinically appropriate elective services—or existing services from new locations —we want to see them properly and swiftly accredited by local commissioners. Where providers meet local criteria for those services—which must be transparent, proportionate and non-discriminatory—providers should be awarded NHS standard contracts for those services without delay. Patients would then be able to choose services through the NHS e-Referral Service.
I hope that my responses have served to reassure the noble Lords, Lord Hendy and Lord Warner, and my noble friend Lord Lansley, that the Government are very much in tune with their thinking on these matters and that the points they have sensibly raised through the amendments have been addressed in one way or another. I hope, too, that the Government’s amendments, to which I have spoken, will have allayed the specific concerns voiced at earlier stages about the regulation-making power in Clause 70. Accordingly, I would invite my noble friend to withdraw his Amendment 98.

Lord Lansley: My Lords, I am most grateful to my noble friend, in particular for the helpful explanation of the impact of the response to the consultation published yesterday, which I think moves us in the right direction on the service conditions in the standard contract on that point. I am grateful for my noble friend’s assurance on Amendment 98 as well. Clearly the power is available in the regulations to make sure that the non-discriminatory element of the procurement regulations can be brought forward in due course, so it need not be in the Bill. I beg leave to withdraw Amendment 98.
Amendment 98 withdrawn.
Amendments 98A to 98C not moved.

  
Clause 69: Regulations as to patient choice
  

Amendment 99 not moved.

Amendment 100

Lord Warner: Tabled by Lord Warner
100: Clause 69, page 63, line 21, at end insert—“6H Survey relating to patient choiceNHS England must annually conduct a public survey of whether patients have been offered choices about where they obtain treatment and must report to the Secretary of State what action they will take as a result of the survey.”

Lord Warner: I am grateful to the Minister for his reassurances on the issue of patient choice. I suggest that the arrangements that he outlined in his response to my amendment are not well known, even  to those such as the Independent Healthcare Providers Network, so I wonder whether he might look at the arrangements for publicising that information. In the meantime, I shall not move my amendment.
Amendment 100 not moved.

  
Clause 70: Procurement regulations

Amendments 101 to 104

Earl Howe: Moved by Earl Howe
101: Clause 70, page 63, line 35, leave out “procurement by relevant authorities” and insert “processes to be followed and objectives to be pursued by relevant authorities in the procurement”Member’s explanatory statementThis amendment changes the principal regulation-making power in relation to procurement so that regulations under the power will have to include provision for procurement processes and objectives.
102: Clause 70, page 63, line 40, at end insert—“(1A) Regulations under subsection (1) must include provision specifying steps to be taken when following a competitive tendering process.”Member’s explanatory statementThis amendment requires procurement regulations to include provision specifying steps to be taken when following a competitive tendering process.
103: Clause 70, page 63, line 41, leave out from beginning to end of line 1 on page 64Member’s explanatory statementThis amendment is consequential on the changes made by another amendment to the principal regulation-making power in relation to procurement.
104: Clause 70, page 64, leave out lines 2 to 6 and insert—“(3) Regulations under subsection (1) must, in relation to the procurement of all health care services to which they apply, make provision for the purposes of—(a) ensuring transparency;(b) ensuring fairness;(c) ensuring that compliance can be verified;(d) managing conflicts of interest.”Member’s explanatory statementThis amendment requires procurement regulations to make provision, in relation to all health care services to which they apply, for the purposes of ensuring transparency and fairness and that compliance can be verified and managing conflicts of interest.
Amendments 101 to 104 agreed.

Lord Duncan of Springbank: I shall not call Amendment 105, as it has been pre-empted by Amendment 103.
Amendment 105 not moved.

Amendment 106

Earl Howe: Moved by Earl Howe
106: Clause 70, page 64, leave out lines 7 and 8 and insert—“(4) NHS England must publish such guidance as it considers appropriate about compliance with the regulations.”  Member’s explanatory statementThis amendment requires NHS England to publish guidance about compliance with any procurement regulations that are made.
Amendment 106 agreed.
Amendment 106A not moved.

  
Clause 71: Procurement and patient choice: consequential amendments etc

Amendment 107

Earl Howe: Moved by Earl Howe
107: Clause 71, page 64, line 31, at end insert—“(b) in section 272 (orders, regulations, rules and directions), in subsection (6), after paragraph (zzd), insert—“(zze) regulations under section 12ZB,”.”Member’s explanatory statementThis amendment means that regulations made under new section 12ZB of the National Health Service Act 2006 (as inserted by Clause 70 of the Bill) will be subject to the affirmative procedure rather than the negative procedure.
Amendment 107 agreed.

Amendment 108

Lord Alton of Liverpool: Moved by Lord Alton of Liverpool
108: After Clause 71, insert the following new Clause—“Health service procurement and supply chains: genocide convention obligations(1) The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England is consistent with the United Kingdom's obligations under the Convention on the Prevention and Punishment of the Crime of Genocide.(2) For the purposes of subsection (1), procurement is not consistent if a Minister of the Crown has assessed that there is a serious risk of genocide in the sourcing region.(3) A Minister of the Crown must make an assessment as to whether there is serious risk if the chair of a relevant select committee of either House of Parliament requests one, and must complete such assessment within two months.”

Lord Duncan of Springbank: I should note, for the convenience of the House, that the noble Baroness, Lady Brinton, will be taking part in this debate remotely.

Lord Alton of Liverpool: My Lords, as we move to Amendment 108, I should declare my interests as set out in the register: my involvement in a number of all-party parliamentary groups, and the fact that I am patron of the Coalition for Genocide Response. I should also declare my support for the other two amendments in the group, Amendments 162 and 173, which will be spoken to by the noble Lord, Lord Hunt, who has trenchantly and consistently pursued the arguments around forced organ harvesting and the public exhibition of anonymous cadavers from Chinese jails. I have spoken in favour of those amendments previously and will not repeat my arguments today.
Like those two amendments, Amendment 108 is an all-party amendment, which was tabled in Committee by the noble Lord, Lord Blencathra, by the noble Baronesses, Lady Hodgson of Abinger and Lady Kennedy of The Shaws, and by myself, and supported by the noble Baroness, Lady Brinton, who is a sponsor today. It would have been moved by the noble Lord, Lord Blencathra, but he has had to self-isolate in Cumbria with Covid, and we all wish him a speedy return to his place.
Yesterday the noble Lord, Lord Blencathra, was able to attend an online meeting with the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, and he asked me to move the amendment in his place. I thank both Ministers for their constructive engagement, and perhaps I might pursue further with them some of the arguments and issues raised yesterday. During our discussion the department told me that it had found no evidence of child labour, forced labour or unethical behaviour. Indeed, that was a repeat of a statement made to me in a parliamentary reply by the noble Lord, Lord Bethell, when he was a Minister.
How does that square with reports to the contrary in the public domain? On what basis was a c grade given to the companies which have been buying merchandise from China? Who went into the Xinjiang factories and forced labour camps? I should say that today at 4.34 pm I was sent a letter from the department saying that 13 performance areas were asked about according to something called amfori BSCI monitoring —it is not explained in the letter what that is and perhaps the noble Earl will be able to tell us—and that they had reached “an acceptable level of maturity.” What does that mean? What is an acceptable level of maturity and how does that square with the so-called c grade that these 13 performance areas had previously been given? Were these in Xinjiang? What were these performance areas? Where were they? Did we look at forced labour camps and what did we see? How was the judgment arrived at? I asked about this in Committee and again during yesterday’s meeting. This is an issue that should go on the public record, and I hope the noble Earl will agree to put the letter that I was sent just before today’s proceedings into the Library of your Lordships’ House so that everyone will be able to study it.
The issues underlining the amendment tabled by the noble Lord, Lord Blencathra, were aired at length in Committee, building on his consistent complaint that we are insufficiently self-reliant and have become too dependent on goods made by slave labour which by their very definition will always be cheaper and therefore destroy competitiveness both here and elsewhere.
In Committee I asked specifically about a Guardian report concerning MedPro. All I have received are coveralls about commercial sensitivity and mediation processes, and that is reiterated in the letter today. That does not give enough information for the House about vast sums of public money and even more importantly about where the goods originated.
To avoid repetition of all the arguments, the signatories of this amendment have circulated an article on yesterday’s edition of PoliticsHome setting out the arguments in favour of the amendment. In summary, the amendment  is about the procurement of merchandise for the National Health Service from states credibly accused of genocide. Why is it needed? It is because of the possibility that perpetrators of this crime above all crimes are benefitting from procurement by the UK Government and because spending taxpayers’ money on the proceeds of genocide and slave labour is unacceptable and should be unconscionable.
Although the amendment is generic and does not name any country, the noble Lord, Lord Blencathra, made it clear in Committee that this would have a significant effect on the procurement of goods from Xinjiang, where both the Foreign Secretary and the House of Commons after a vote declared that a genocide is under way. For the avoidance of doubt, the Department for Health and Social Care’s records show that over the course of the pandemic the department generated orders for 36.9 billion items of personal protective equipment and that of these, 24.1 billion items have a country of origin recorded as China, including 10.7 billion gloves.
In a reply I received last year I was told that we had bought 1 billion lateral flow tests from China. Curiously, the letter I have received today—perhaps again the noble Earl will be able to amplify this—on one hand says it would be commercially sensitive to tell me what has been spent on these items of PPE and specifically on lateral flow tests, but elsewhere tells me that £4.8 billion has been spent. So, it is either commercially sensitive or it is not, and I do not understand what the figure therefore relates to.
So how does the amendment address this? What is its purpose? In the light of reports of slave labour-made PPE entering our supply chains, it meets the clear and urgent need to address health procurement. Recall that Dominic Raab rightly described the industrialisation of more than 1 million incarcerated Uighurs in Xinjiang. The amendment requires the Government to address our heavy dependence upon regions which, in whole or part, produce slave-made PPE and which too often goes unaddressed. This House is being consistent with its earlier decisions in urging the Government to come forward with a comprehensive policy on genocide which is long overdue.
As the noble Lord, Lord Blencathra, said in Committee, in comparison with the bipartisan legislation in the United States, with its rebuttable presumption on all trade with China, this amendment is modest. In a proportionate and balanced way, it does not circumnavigate the Government’s position that a determination of genocide is for competent courts only. It only requires a response where serious risk of genocide is said to occur. If the Foreign Secretary is right, how can we justify spending billions of pounds on billions of items made by slave labour in a state that she has accused of genocide? The amendment lays a duty on a Minister of the Crown to assess whether there is a risk of genocide in the sourcing region if the chair of a relevant Select Committee of either House requests such an assessment to be made.
It is worth reminding the House that the list of those supporting the amendment includes the British Medical Association, Accountability Unit, atrocity prevention organisations such as the World Uyghur Congress and many others. I also drew the attention of the seminar about this amendment held in your Lordships’  House two days ago to the valued support of my noble friend Lord Stevens of Birmingham, the former chief executive of the National Health Service.
Why would anyone want to oppose this? The department tells us that it is not appropriate to address genocide in a health Bill. However, not only is there a specific and huge issue centred on National Health Service procurement—very much a Department of Health and Social Care issue—but genocide is not a narrow departmental matter. It is something which, under the 1948 convention on the crime of genocide, we are all required to address, in whatever capacity and right across government. The department is also bound by the law. The requirements are set out in Theresa May’s landmark legislation, the Modern Slavery Act, which I gave my total support to when it passed through your Lordships’ House in 2015. There are legal duties here.
I also take this opportunity respectfully to suggest to the noble Earl that we must not make sweeping claims about the good state of our health supply chains. There is much more to this than the Telegraph report which linked £150 million of PPE directly to Xinjiang. I mentioned to the noble Earl in conversation that Professor Laura Murphy’s seminal report In Broad Daylight details various NHS providers who are heavily implicated in China’s labour transfer schemes, which are widely acknowledged to be involuntary work schemes targeted at ethnic minorities.
I am also aware that analyses are under way of NHS-procured PPE, which is highly likely to show that many constituents originate in Xinjiang. I particularly draw the attention of the House to the extraordinary and remarkable speech the noble Lord, Lord Rooker, made in Committee, where he talked about the work of Oritain and how it can determine right down to the last shred the origins of cotton. That is obviously very significant in this context, and I was grateful that the final paragraph of the letter I have referred to says that the department’s officials will be happy to meet Oritain. That is extremely welcome.
While I am at it, I also refer the noble Earl to the House of Commons Business, Energy and Industrial Strategy Committee’s fifth report of Session 2019-21, which said:
“We were disappointed by the Government’s statement, as it introduced no significant new measures to prohibit UK businesses from profiting from the forced labour of Uyghurs in Xinjiang and other parts of China. We are also deeply concerned about reports that the Government procured personal protective equipment from factories in Xinjiang and other parts of China implicated in modern slavery during the early part of the Covid-19 pandemic.”
So, this is not scaremongering on the part of noble Lords or people who are perceived to be hostile to the Chinese Communist Party. This is a reputable report from a House of Commons Select Committee for people of high academic distinction. The noble Earl will perhaps want to study it in more detail.
The department tells us it is not appropriate to address genocide in a health Bill, but not only is there a specific and huge issue centred on NHS procurement—very much a health department issue—but genocide is not a narrow departmental matter: it is, as I said, something that every department in government needs to address, and the House needs to reach decisions on this and on the other two amendments in this group.
I end by simply citing public support: two-thirds of those polled, some 65%, say they would support preventing the Government from procuring health equipment for the National Health Service from regions where they believe there is a serious risk of genocide. So there is widespread public support for what the promoters of this all-party amendment are asking the House to do. The House should seize this opportunity to ensure that our National Health Service is free from slave labour and, on behalf of the noble Lord, Lord Blencathra, I beg to move.

Lord Duncan of Springbank: I now call the noble Baroness, Lady Brinton.

Baroness Brinton: My Lords, I am sorry to hear that the noble Lord, Lord Blencathra, is unwell, and I thank the noble Lord, Lord Alton, for his excellent introduction to Amendment 108, to which I have added my name. I also support the other two amendments in this group, which are in the name of the noble Lord, Lord Hunt, who I commend for his consistent campaign on these issues over the years. His Amendment 162 would ensure that there must be informed consent, with no coercion or financial gain, when organs are donated or when UK citizens go abroad for transplants. Amendment 173 would ensure that cadavers would no longer be used for public display unless it is the body of a person which is at least 100 years old, because, as with Amendments 108 and 162, there is real concern that people have been forced to have organs removed, or their bodies have been used after their death—sometimes murder, sometimes execution—but without their consent.
Returning to Amendment 108, it has two clear objectives: the first is to prevent the Government procuring health service goods produced in regions where there is a serious risk of genocide. While the Government say there is no evidence, a New York Times investigation found that PPE made through the Xinjiang labour transfer programme was present in US and international healthcare systems. As we have heard from the noble Lord, Lord Alton, there is increasing evidence that the NHS has procured such items already.
The second objective is to create a process through which the UK Government can be required to assess regions for serious risk of genocide and publish their assessment. This is necessary because the UK Government have given out PPE contracts worth almost £150 million to Chinese firms with links to forced labour abuses in the Uyghur region.
The Government have said that genocide amendments are not appropriate in the Bill and that the Modern Slavery Act 2015 offers protection, but the reality is that the UK is not leading the world here. The US Uyghur Forced Labor Prevention Act creates a “rebuttable presumption” banning all goods sourced in whole or in part from the Xinjiang region of China, unless clear and persuasive evidence can be provided to the contrary; and the European Union is now considering bringing forward new legislation to ban products made with forced labour from entering the European market. The UK’s Modern Slavery Act does not go nearly as far as either of these proposals, merely requiring that companies publish—but not that they act upon—modern  slavery statements. People’s lives and human rights are at stake here. Frankly, it is time the UK followed suit with stronger legislation. This amendment would be a strong and careful start that means government and Parliament cannot look away. I look forward to the Minister’s response.

Baroness Kennedy of The Shaws: I shall speak very briefly, because I am conscious of the time and that we have a lot of business to do. This amendment seeks nothing more than to create another human rights threshold for health procurement, adding to those that are already in place, which seek to address slavery but have major shortcomings, as the noble Baroness, Lady Brinton, has just described. I keep hearing it being said that a health Bill is not the proper place for an amendment concerning genocide. Well, I am afraid that I do not agree. This is an appropriate place.
We are not asking the Government or the Department of Health to decide whether there is a genocide taking place; we are asking the Minister to take on the duty to assess whether the source of instruments, test kits, protective equipment or whatever may be from forced labour and a situation of slavery. Xinjiang province is the obvious place for us to be concerned about, but there are other places—for example, in India—that we should be concerned about too, and I think that placing that duty on the shoulders of the Minister is a way of concentrating minds. That is why I really press this amendment and I pay tribute to the way the noble Lord, Lord Alton, has so assiduously pursued this. That is all I wanted to say, but I will support this amendment and I urge the House to support it too.

Lord Hunt of Kings Heath: My Lords, it is a great honour for my two amendments to be grouped with that in the names of the noble Lords, Lord Alton and Lord Blencathra. As the noble Lord has discussed the supply chain, I should declare my interest as president of the Health Care Supply Association, although I am not speaking on its behalf when it comes to my strongly supporting his amendment, which sets the context for my own two amendments.
We debated this issue very fully in Committee. I think that the House believes strongly that the commercial exploitation of body parts in all forms is unethical and unsavoury. When it is combined with mass killing by an authoritarian state, we cannot stand by and do nothing. In 2019, the China Tribunal, led by Sir Geoffrey Nice QC, stated:
“The Tribunal’s members are certain—unanimously, and sure beyond reasonable doubt—that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”
In June this year, 12 UN special procedure experts raised the issue of forced organ harvesting with the Chinese Government in response to credible information that Falun Gong practitioners, Uighurs, Tibetans, Muslims and Christians had been killed for their organs in China.
Currently, human tissue legislation covers organ transplantation within the UK, where we have a very ethical approach, but it does not cover British citizens travelling abroad for transplants, and British taxpayers’  money will pay for anti-rejection medication regardless of where the organ was sourced or whether it was forcibly harvested from prisoners of conscience.
I shall not repeat all that I said in Committee, but I have had a helpful meeting with Ministers for which I thank them. In that meeting and in subsequent meetings, the Minister was concerned that my amendment in relation to organ tourism would penalise vulnerable people seeking to pay for a transplant. I have thought about that carefully, but, in the end—and the noble Baroness, Lady Kennedy, expressed so well why this Bill is highly appropriate for these kind of amendments—we have to draw a line in the sand. That is particularly so today, in the horrific circumstances that we meet. We have to draw a line in the sand and send out a powerful message globally that we will not support these abhorrent practices in any way.
My Amendment 162 comes later, but I shall seek the opinion of the House at that time.

Baroness Northover: The noble Lord, Lord Hunt, has very effectively introduced the amendments to which I have put my name, Amendments 162 and 173, and I wish briefly to express the support of these Benches for those. We also support Amendment 108, to which my noble friend Lady Brinton has put her name.
As noble Lords know, we have been inching forward on these matters with Ministers, and I welcome that forward movement. I note, however, recent warnings from Ministers that, for example, there are “opportunity costs” in implementing these measures, as ensuring that proper standards are enforced requires effort and potential cost. I understand that. Nevertheless, we cannot allow ourselves to become complicit in any way in organ tourism where the source of those organs is forced or where selling the organ is to address appalling poverty.
Some say that this trade may be declining in and from China. If so, that is welcome and might reflect international pressure, not least on the Chinese medical profession. It is not clear that those involved in the China Tribunal and the Uyghur Tribunal would agree that it is declining.
Even if we were to accept that, and Ministers seemed to indicate that they thought that might be the case, we are also hearing now of an increase in the selling of organs in Afghanistan because of the dire situation there. There have been recent reports of journalists seeing the scars of those who have sold their kidneys. That is a terrible indictment of our walking away from Afghanistan and failing to address the appalling conditions that we have left there. How can we regard such potential “donors” as being anything other than the most extremely vulnerable? How can you put that up against the vulnerable who may need to have donations?
As for the bodies exhibitions, we have discussed before how distasteful they are—but then we realise with horror exactly where these bodies seem to have been sourced: among other things, from Chinese prisons. We should never have condoned that, turning a blind eye. I agree with the noble Baroness, Lady Thornton, who argued in Committee that they should simply be banned. There is no reason whatever to agree to their continuation.
I now hear that the Government may argue—and this is incredibly familiar—that these amendments are flawed. As the noble Earl knows, often Ministers are given briefs that say, “This is a flawed amendment, so turn it back.” I am very familiar with them. In those circumstances, the best thing is for your Lordships to pass these amendments, because Ministers know, or should know, that the essence is extremely clear, and with government lawyers we can work out how best to sort out any unintended consequences. I hope that I do not hear anything about these amendments being flawed—and I say that to the Box. I therefore commend them to your Lordships.

Baroness Finlay of Llandaff: My Lords, I support all the amendments in this group, and I shall speak specifically and briefly to Amendments 162 and 173.
These amendments are updates to the Human Tissue Act, which was born out of public outrage following the Alder Hey scandal, when over 100,000 organs, body parts and entire bodies of foetuses and stillborn babies were stored in NHS facilities. The body parts of dead patients, including children, were removed without consent. Today, the Human Tissue Authority’s guiding principles, as set out in its code of practice, are consent, dignity, quality, honesty and openness. These principles should not only reflect how human tissue sourced from within our own nation is treated, we must treat human tissue and organs with the same principles when sourced overseas.
In China, as has been said, there is substantial evidence of Falun Gong practitioners and Uighurs—as well as some evidence of Tibetans and house Christians—being killed on demand for their organs. Blood is taken off them for tissue-typing at the time when they were taken into custody, often with no idea why they were taken into custody at all, other than that they belong to one of those groups. There is no consent, no dignity and no transparency.
On 7 December last year, the British Medical Association released a statement on the abuse of Uighurs in China, expressing
“grave concern regarding the situation in China and the continuing abuse of the Uyghur population of the country as well as other minorities.”
It went on to state:
“We are particularly alarmed by the reports of organ harvesting, forced birth prevention, and the use of genomics data for racial profiling.”
It urged
“the UK government and international actors to exert pressure on the Chinese government to cease its inhumane actions towards the Uyghurs”.
If we do not pass amendments as laid before the House today, we will be complicit with these practices, because we will be looking at them with Nelson’s eye, with all the evidence that we have that they are going on.
On Amendment 173, on the exhibition of whole bodies using a plastinated technique, I suggest that there is no transparency whatever. Any attempt to claim that there has been consent is extremely suspect, because consent is very easily falsified. I went to one of these exhibitions because I thought you ought to go  and see what you are criticising. This was not an anatomical, educational experience but a visual display of plastinated bodies in all kinds of different poses. But the one that horrified me the most was a pregnant woman, quite advanced in her pregnancy and with the foetus in her womb, which had been plastinated. I do not believe that that woman would have given consent for plastination. That raised real questions as to why such an advanced foetus was in the womb of a dead woman without something there explaining the nature of her death, the cause of death and the circumstances in which she had decided to consent to such a procedure.

Baroness Smith of Newnham: My Lords, I will speak to Amendment 108, while supporting the other two amendments introduced so powerfully by the noble Lord, Lord Hunt, and my noble friend Lady Northover, and to which the noble Baroness, Lady Finlay, spoke so eloquently.
I am completely in support of those amendments, but I wish to speak briefly to the genocide amendment today. On various occasions during the Covid pandemic questions were asked of the then Health Minister about the procurement of PPE. He was not able to give me a straight answer to say, “We can guarantee that no PPE procured could have had anything to do with slave labour or could have come from Xinjiang.”
The NHS seeks to be world leading. We all support it and want it to be able to deliver for every citizen in this country. But that should not be at the expense of the lives of those in other parts of the world. It is not good enough to say that we have the Modern Slavery Act if that will not lead to a change in practices. It is absolutely essential that our supply chains do not include anything that comes from forced labour.
If one looks at what is going on in Xinjiang, it is possible to barter to get numbers of people, just as it was 200 years ago during the slave trade. That is not acceptable. It may be the case that, as the noble Baroness, Lady Kennedy of The Shaws, pointed out, we will be told, “This is not the right piece of legislation.” If it is not, what will the Government bring forward that will mean that every point of our supply chain—every part of government procurement—ensures that we are not procuring things that have been made using slave labour?
We must not be complicit. This House should support the amendments, and if the Minister is not able to support the amendment, perhaps he could come back with a revised and better version of the amendment that will do what we all seek to achieve.

Lord Moylan: My Lords, I will speak briefly only to Amendment 108, which I understand the Government are likely to resist when my noble friend the Minister comes to speak. I say simply, very briefly, that to be persuasive, my noble friend has to explain how through administrative measures the National Health Service will achieve the effects of this amendment. He has to explain that in a credible way and that the effects will be rapid and comprehensive. Any idea that this will be kicked into a long review that ambles on and may or may not produce the effects required by at least the first two proposed new subsections of the  amendment will lack credibility; I am less concerned about the chairman of the Select Committee part that comes in the third one. I would like my noble friend to know before he speaks that that is what I think we all want to hear.

Baroness Walmsley: My Lords, China has been found out. Thanks to surveillance and other types of technology, and courageous on-the-ground reporting, it is clear that China does use slave labour. As we know, the UK has a duty under the genocide convention, and there is strong evidence that much of the material produced by slave labour, even possibly by genocide, is being used by NHS staff—and even by noble Lords ourselves when we use lateral flow tests, since we are not confident about where they came from. They come from areas where there is serious risk of genocide and as the noble Baroness, Lady Kennedy, said, it is not necessary to determine genocide in order to be obliged to do a risk assessment and take action; and we are not doing enough of that. Over half of these products come from places where there is no conflict, so action against conflict is not adequate. More needs to be done. We must not fail to do it because it is more convenient to buy products to keep us safe without investigating how they are produced. Our safety must not be on the backs of people whose rights, and even their lives, are being taken from them.
The same applies to organ-harvesting from unwilling donors. There is incontrovertible evidence that it is not just happening but happening increasingly, and it absolutely has to stop. My noble friend Baroness Northover made a strong case that the exhibiting of cadavers should not happen in a civilised society, and I hope that the Minister is going to tell us how the Government are going to stop it.

Lord Eatwell: My Lords, I rise to give my strong support to Amendment 108, and I do so because of the terms of the genocide convention to which this Government are committed and are obligated to support. It is important for the House to note that genocide is not defined solely as mass killing. It is also defined as
“causing serious bodily or mental harm … deliberately inflicting … conditions of life calculated to”
destroy the protected group
“in whole or in part … imposing measures intended to prevent births”,
and
“forcibly transferring the children of the group to another group.”
The Government are a signatory to the genocide convention, and I think the noble Earl, Lord Howe, is obligated by that signature to support this amendment.

Baroness Merron: My Lords, it is impossible to turn away from the connection between procurement of products and services and the message and support that such procurement may give to those who seek to exploit, oppress, damage and murder.
I thank the noble Lord, Lord Alton, for introducing this amendment, in the name of the noble Lord, Lord Blencathra, who we wish well. Genocide and the abuse of human rights do not respect the imposed boundaries of government departments, and that is  why it is appropriate that these amendments, which have extensive support both inside and outside your Lordships’ House, have been tabled today. Amendment 108 has cross-party support and if the will of the House is tested, we on these Benches will support it.
The NHS is the biggest single procurer of medical products in the world. It has a huge amount of leverage to be a force for good or otherwise when it comes to ethical procurement. It can starve abusive regions of resources. It can also remove a veneer of acceptability from those regions.
If we are serious about being global Britain and a force for good in the world, we need to act as such. It is surely wrong that, for example, we are using bandages which have been produced by forced labour. We must hold the Government to their commitment to provide guidance and support to UK government bodies to use public procurement rules to exclude suppliers where there is sufficient evidence of human rights violations in any of their supply chains. As expressed by my noble friend Lady Kennedy, this is about giving the Minister the opportunity to act. It is about focusing minds. I hope that the amendment will find favour with the noble Earl.
In Committee, my noble friend Lord Collins spoke of the need not to be tied down by a very strict legal definition of genocide. He also emphasised that we must focus on broader human rights issues. As the noble Lord, Lord Alton, said, we need to take a comprehensive, joined-up approach. Amendment 108 gives us this opportunity.
I thank my noble friend Lord Hunt for continuing to press home the need for action, as outlined in Amendments 162 and 173. We heard explicitly and movingly about the realities of how this affects people’s bodies, alive and dead, and the distaste and abuse related to it. It is surely right that UK citizens are safeguarded against complicity in forced organ harvesting as the result of genocide. Countries such as Spain, Italy, Belgium, Norway and Israel, among several others, have already taken action to prevent organ tourism in respect of China. We have the opportunity to do so today.
I hope that the noble Earl will feel able to accept these amendments. I am grateful to the noble Lord and his officials for the opportunity to discuss these matters. I hope only that your Lordships’ House can assist in improving this aspect of the Bill by taking action, as we should, about genocide and the abuse of human rights.

Earl Howe: My Lords, the amendments in this group bring us to three discrete topics which are nevertheless linked by a common thread—that of human rights. Because they engage us in issues of great sensitivity, I begin by saying something that may sound unusual. There is probably no one in this Chamber who is not instinctively drawn towards these amendments. All three are honourably motivated. In pointing out any shortcomings, I would not want noble Lords to think that the Government did not understand or sympathise with why they have been tabled.
I will start with the issue of organ tourism. Like the noble Lord, Lord Hunt, I find it abhorrent that individuals exist who are in the business—often the lucrative  business—of sourcing human organs from provenances that are both illegal and supremely unethical. They then entice desperate and seriously ill people to go to a foreign country to have such organs transplanted within them. This idea is unconscionable. As far as we can, we should have no truck with it. The Human Tissue Act already prohibits the giving of
“a reward for the supply of, or for an offer to supply any controlled material”
in any circumstance where a substantial part of the illicit transaction takes place in England, Wales or Northern Ireland.
The Modern Slavery Act makes it an offence to arrange or facilitate another person’s travel, including travel outside the UK, for the purposes of their exploitation, which includes the supply of organs for reward in any part of the world. The law as it stands addresses a substantial element of potential criminality. How widespread is this criminality? What do we know about the scale of organ tourism as it relates to UK residents? I have obtained some figures from the department. In 2019-20, the last reporting year before international travel was curtailed by the pandemic, a total of 4,820 organ transplants took place in this country. At the same time, NHS Blood and Transplant data shows that only seven UK residents received a transplant abroad, many if not all legitimately, and had follow-up treatment in the UK.
Therefore I am thankful to say that the scale of the problem of illicit organ tourism, as it relates to UK residents, is small. If the noble Lord, Lord Hunt, were to say to me that one such case is one too many, I would agree, but the House should not support this amendment, because it is not right to support an amendment that could cause vulnerable transplant patients who receive a legitimate transplant overseas to face imprisonment because they may not have the right documentation. That is what the amendment could lead to. Checking such documentation and creating individually identifiable records for every UK patient who has received a transplant overseas would put healthcare professionals in an invidious and inappropriate position by blurring the line between medic and criminal investigator.
More to the point, it could also prevent those who legitimately receive an organ transplant abroad—particularly those from minority-ethnic backgrounds—from seeking follow-up treatment, for fear of being treated as a criminal suspect. Following that thought through, I say that the effect that this amendment could have in exacerbating health inequalities is likely to be far greater than its effect in deterring transplant tourism, especially, as I have emphasised, because there are already legal provisions in place covering most cases of organ tourism.
I listened with care to the noble Baroness, Lady Finlay, particularly regarding her examples of the exhibition that she went to. I join her in being somewhat incredulous that there could be consent to some of the exhibits that she witnessed. However, where consent has been obtained, it must be unequivocal. As I emphasised, the law as it stands now prohibits the exhibition of bodies or body parts where express consent cannot be fully demonstrated.  I undertake to speak to the Human Tissue Authority, to see that, should there be another exhibition of this kind proposed, there is full transparency in the form of labels under each exhibit making clear how consent was obtained and what it consisted of.
Targeting those who receive an organ, rather than the traffickers and their customers who initiate or negotiate the arrangements, risks imprisoning vulnerable patients who may have been misled as to the provenance of their organ. That would be disproportionate. The Government’s view remains that the best approach is to continue targeting traffickers and their customers, while doing all that we can to help UK residents who are in need of an organ by focusing our efforts on improving the rates and outcomes of legitimate donations.
I turn to Amendment 173 relating to the public display of cadavers. Again, this is an issue of great sensitivity about which we all have personal views. I am sorry that I read out the wrong reply to the noble Baroness, Lady Finlay, just now. The noble Lord, Lord Hunt, has been assiduous in pursuing the case for a complete ban on these displays and we have heard the powerful case that he and others put in support of such a ban. But once again I will say why I think the amendment should not be supported.
The law already prevents new public displays of bodies and body parts where the donor has not given their express consent, and that is as it should be. The question we now need to answer is whether the law should also prevent the display of bodies and body parts where such express consent has been given. This is where I return to the points I made about the speech of the noble Baroness, Lady Finlay. There may well be individuals who express their desire to donate their bodies after death for the purpose of an exhibition devoted to the display of the human anatomy. Some people sincerely feel that such exhibitions have educational and artistic merit on the grounds that they provoke interest in the inner workings of the human body. Some of us may find the idea of such exhibitions distasteful, but I say gently to noble Lords that in a liberal and free society such as ours it is not the role of government or, I suggest, this House to be the arbiter of taste. We should respect the principle that we have always championed in our debates concerning human tissue, which is that of informed consent. I suggest that this case is no different.
In turning to Amendment 108, I recognise the enormous strength of feeling in the House on the human rights violations that we hear from many sources are being perpetrated in Xinjiang. I also acknowledge the concerns raised by several noble Lords that items procured by the NHS may be sourced from regions where forced labour or other serious violations of human rights are occurring. As we have heard, this is a complex issue—complex because supply chains are complex—and I do not wish to sound complacent or uncaring if I say that there are no easy answers. But I reassure the House that the Government are resolutely committed to taking robust action to tackle this challenge, not just in the NHS but across all our supply chains. I will demonstrate to the House exactly how we are doing that, both currently and prospectively.
Over the past year, we have introduced a number of robust, evidence-based measures to help ensure that no UK organisation, public or private, is complicit in the human rights violations occurring in Xinjiang. Those measures include new guidance for UK businesses on the risks of doing business in Xinjiang, the announcement of enhanced export controls and commitments to introduce financial penalties for non-compliance with Section 54 of the UK’s Modern Slavery Act, as well as new procurement guidance to help exclude companies linked to modern slavery violations.
We are also working closely with international partners to ensure a co-ordinated approach to supply chains. Under our G7 presidency last year, G7 leaders committed to working together to ensure that global supply chains are free from the use of forced labour. That effort is government-wide and across all sectors of business.
Within the NHS specifically, we have taken and continue to take action in line with procurement and modern slavery law. Since 2020, NHS Supply Chain has utilised the UK Government’s portal, the Supplier Registration Service, to undertake assessments of both modern slavery and labour standards where, through risk assessment, a contract is deemed high-risk. We fully recognise, however, that further work is needed across government to meet the scale of the challenge. That is why the Government have announced a comprehensive review of their 2014 modern slavery strategy, with a new strategy due to be published this spring. This is a major undertaking, including a thorough review of all aspects of our approach to tackling modern slavery. We are also looking at introducing further measures through the upcoming procurement Bill. Those measures would be in addition to new legislation to strengthen further and future-proof the transparency and supply chain provisions of the Modern Slavery Act, when parliamentary time allows.
This ongoing work does, I trust, demonstrate the Government’s commitment to taking a robust, holistic and co-ordinated approach to meet the complex challenge posed by the risk of human-rights violations in global supply chains. That is why, despite our having no doubt as to the honourable intentions behind this amendment, we do not believe that building it into the Health and Care Bill would further our efforts in taking robust action to address human rights violations, wherever they may take place.
The UK is strongly committed to early and effective action to prevent all mass atrocities—whether that is genocide, war crimes, crimes against humanity, or ethnic cleansing—and we will do this through a variety of means: early-warning tools, diplomacy, development and programmatic support, human rights monitoring, and coercive measures such as sanctions and defence tools. Our work in this area is long-standing, both in terms of preventing atrocities and in securing accountability and justice for atrocities committed. The issues and concerns raised today by the noble Lord, Lord Alton, and other noble Lords require a comprehensive and carefully considered response befitting both their gravity and complexity. We do not, however, consider this Bill to be an appropriate instrument through which to tackle this issue.
That said, I acknowledge the strength of feeling in this House relating to the NHS, specifically about ensuring that no part of the NHS is inadvertently complicit in human rights violations, where they exist in supply chains. Therefore, in addition to the range of measures we are already taking, I am pleased to make a commitment that the department will undertake a new, focused internal review of NHS supply chains to address the concerns that have been expressed with regard to the risk of exposure. In conducting this review, the Government would welcome further engagement with the noble Lord, Lord Alton, my noble friend Lord Blencathra, and, indeed, all noble Lords who have spoken in this debate. Your Lordships’ insights will, I have no doubt, be greatly valued as we take forward this important work. I was grateful to the noble Lord, Lord Alton, for the references and pointers that he mentioned in his speech.
I hope that this provides noble Lords with further reassurance about the Government’s approach but, more than that, I hope that the undertaking I have just given, combined with the statements I have made to the House about the extensive work now in train across government to bear down as hard as we can on modern slavery and the abuse of human rights across the world, may persuade the noble Lord, Lord Alton, to withdraw Amendment 108.

Baroness Finlay of Llandaff: Before the noble Earl sits down, may I apologise to the House? I should have declared that I am the UK chair of Commonwealth Tribute to Life, which aims to establish a memorandum of understanding across the Commonwealth over ethical transplantation.
The Minister, in his reply, spoke of seven patients who are known to have travelled abroad for organs. Most of those were legally arranged, so the numbers are very small; yet the clinical services in the UK are not aware that it is illegal to arrange to purchase an organ abroad if most of that transaction happens in the UK, or to procure the travel to go. I wonder whether the Minister would be able to undertake to work with us in NHSBT to ensure that all the clinicians working in the field are aware of this and can brief patients appropriately at the time they sign up to be on the transplant list, so that they understand that, although they are eligible for a transplant, they should not be seeking transplants in other countries, even when tempted to do so. It can look quite alluring, and I am concerned that, within the profession itself, there might be some misunderstanding. I realise this is a difficult question and the Minister might prefer not to answer it now; it might be something we could discuss later.

Earl Howe: My Lords, that is a perfectly valid question from the noble Baroness, and I would be happy to take that back to those in the Department of Health and Social Care who have direct responsibility in this area.

Lord Alton of Liverpool: My Lords, I know that this is a complex and long Bill, and that the House will want to move quite quickly to the next business. I will end by simply thanking every noble Lord who has participated in today’s debate, especially the noble Baronesses, Lady Walmsley and Lady Merron, from  the opposition Front Benches, and the noble Lords on the Government Benches who have supported the noble Lord, Lord Blencathra, and the noble Baroness, Lady Hodgson, at every stage of the progress of this amendment.
I know that when the noble Earl, Lord Howe, said that he was instinctively drawn to these amendments, and that he found many of these practices abhorrent, he was speaking as he feels. I am grateful to him, not only for the meeting that we had yesterday with the noble Lord, Lord Kamall, but for his promise to look at this further. Among those to whom I would like to introduce him is a Uighur surgeon I have met, who has given evidence here in the House about being forced to remove organs and to kill the patient in the course of that. This is the ethical issue here. If people profit from that in any way whatever, even if inadvertently, we must not be complicit.
A year ago, we were promised that there would be an urgent review of exports to Xinjiang and fines for businesses which failed to comply with the Modern Slavery Act, when parliamentary time allowed. Those things have not happened. The urgent review has just been completed, but it ended up dealing only with military exports and there have been no fines applied one year later. It is never the right Bill or the right time. The noble Lord, Lord Forsyth, and I were told this on the telecommunications Bill, we were told it again on the then Trade Bill. We are told it on every Bill. That is why it is inevitable that we come back with amendments like this until the comprehensive plan, to which the noble Earl referred, actually happens.
The House really needs to send this amendment further. We have had between Committee and now for the Government to help us redraw it, if there are any defects or flaws. I am unaware of what they may be; they have never been pointed out to us. The noble Earl also knows that the Government could say to us, “Bring this back at Third Reading and we will help to draw up such an amendment.” However, I am told that this is not possible either. Therefore, the only way for us to ensure that this amendment can proceed and be perfected is to send it to another place. I am glad to be able to tell the House that a former leader of the Conservative Party, Sir Iain Duncan Smith, has agreed that he will personally promote this amendment if it is passed in your Lordships’ House today and take it further there. He says that he is with us 100%. I would like to seek the opinion of the House.
Ayes 110, Noes 91.

Amendment 108 agreed.

Amendment 109

Lord Kamall: Moved by Lord Kamall
109: After Clause 77, insert the following new Clause—“Meaning of “health” in NHS Act 2006In section 275(1) of the National Health Service Act 2006 (interpretation), at the appropriate place insert—““health” includes mental health;”.”Member’s explanatory statementThis new Clause clarifies that in the NHS Act 2006 “health” includes mental health (unless the context otherwise requires). Although the natural meaning of health is capable of including “mental health” the existing provisions of the Act are inconsistent about whether they mention mental health expressly which could cause confusion.
Amendment 109 agreed.

  
Clause 79: Abolition of Local Education and Training Boards.

Amendment 110

Lord Kamall: Moved by Lord Kamall
110: Clause 79, page 69, line 42, at end insert “and the “and” before it”Member’s explanatory statementThis amendment is consequential on Clause 79(3) of the Bill, which omits paragraph (c) of section 100(4) of the Care Act 2014.
Amendment 110 agreed.
Amendment 111 not moved.

Amendment 112

Lord Warner ): Moved by Lord Warner )
112: After Clause 80, insert the following new Clause—“PART 1AHEALTH AND CARE SUSTAINABILITYOffice for Health and Care Sustainability(1) There is to be a body corporate, independent of the Government, called the Office for Health and Care Sustainability (“the Office”) to safeguard the long-term sustainability of an integrated health and adult social care system for England.   (2) The Office must be established within six months of the passing of this Act and must publish a report of its initial findings relating to its main functions within a year of its establishment.(3) The role of the Office is to continually assess the outlook for the health and care system over the coming five, 10 and 15 years.(4) The Office has no function in operational or service delivery aspects of the health and care system.(5) The Office must—(a) monitor and publish data relating to demographic trends, disease profiles and the likely pace of change relating to future service demands,(b) assess the workforce and skills mix required to respond to those changes and publish regular reports on those matters, and(c) consider the stability of health and adult social care funding relative to changing demographic and disease trends, including the alignment between health and adult social care funding, and publish regular reports.(6) The functions of the Office are to be exercised on behalf of the Crown as if it was a public department.(7) The Office is to consist of—(a) an executive chair appointed by the Secretary of State with the consent of the Public Accounts and Health Select Committees of the House of Commons,(b) two other members appointed by the Secretary of State with the consent of the Public Accounts and Health Select Committees of the House of Commons, and(c) two other members nominated by the Office and appointed by the Secretary of State.(8) The initial appointments under subsection (7) are for a term of five years and no more than two terms may be served.(9) The remuneration of the executive chair is to be agreed by the Secretary of State but may not be less than that paid to the Permanent Secretary of the Department of Health and Social Care; and all other salaries and gratuities for members may be agreed by the Office with the consent of the Secretary of State for Health and Social Care.(10) The Office may employ staff on terms and remuneration consistent with that of the civil service.(11) The Office may—(a) establish such committees and sub-committees as it deems necessary,(b) determine its own procedures and those of its committees and sub-committees, and(c) do anything calculated to facilitate, or conducive or incidental to, the carrying out of any of its functions.(12) The annual budget of the Office is to be provided by the Secretary of State after consultation with the Public Accounts Committee of the House of Commons.(13) The Office must keep proper accounts and records in relation to its accounts, and must prepare and publish each year an audited statement of accounts.(14) The Office must prepare an initial report on its work within one year of its establishment, and thereafter annually, and may at any time publish a report on its functions when it considers that this assists safeguarding the long-term sustainability of an integrated health and adult social care system in England.(15) The Secretary of State must lay any report prepared by the Office before both Houses of Parliament.”Member’s explanatory statementThis amendment implements recommendations 33 and 34 of the 2017 report by the House of Lords Select Committee on the Long-term Sustainability of the NHS and Adult Social Care. It draws on the legislation setting up the Office for Budget Responsibility.

Lord Warner: My Lords, Amendment 112 is my name and the names of the noble Lords, Lord Hunt, Lord Scriven and Lord Kakkar. I am grateful for their support. This amendment goes much wider in terms of independence from the Secretary of State than Amendment 80, moved so convincingly by the noble Baroness, Lady Cumberlege, earlier today.
Amendment 112 establishes a new body to help to secure the long-term sustainability of our health and care system. That body is an independent office for health and care sustainability as recommended by this House’s Select Committee on the Long-term Sustainability of the NHS and adult social care. This new body is based on the model of the Office for Budget Responsibility. That body is widely accepted as having worked well over a number of years. My amendment draws heavily on the 2011 legislation setting up the OBR.
The new office of health and care sustainability has three main functions which are set out clearly in the amendment, so in the interests of time I will not repeat them. The new body would look five to 10 to 15 years ahead and publish regular reports which would be laid before both Houses of Parliament. It would produce an initial baseline report within a year of its establishment. Like the OBR, the new body would have an executive chair and five members. The chair and two members would be appointed by the Health Secretary but—and this is a very big but—with the consent of the House of Commons’ Public Accounts Committee and Health and Social Care Committee. The remaining two members would be chosen by the office itself. Like the OBR, the new body would not have a membership controlled by Ministers.
The new office of health and care sustainability would be much more independent of the Secretary of State than is provided for in Amendment 80. It would have a much wider remit in terms of improving the balance between the NHS and social care, on both staffing and funding. The greater long-term independence seems essential given that the Department of Health—now the Department of Health and Social Care—has a political and official track record which was revealed to the Lords Select Committee as pretty unsatisfactory.
The Department of Health has been failing to plan for the future for a very long time. The evidence given by its Permanent Secretary totally failed to convince the Select Committee that it took long-term planning seriously. That Permanent Secretary is still in place. I do not like personal attacks, but in evidence to the Select Committee this person actually said that he did not see long-term planning as part of his job description. So we have a situation where the long-term planning of the NHS and social care is simply not on the agenda of the government department responsible for it.
With this track record and the Covid recovery programme that the Department of Health and Social Care now faces, it seems to me a triumph of optimism over reality to rely on that department and its harassed political head to undertake long-term planning. I say that despite the House passing Amendment 80. We are looking for a situation in which there is more independence of the Secretary of State and, indeed, more independence in the collection of information, the sifting of that  information, and the analysis that that information shows—and that covers funding as well as workforce issues.
I am pleased to say, however, about the report that was presented to the then Health Secretary, Jeremy Hunt, although it seemed at the time not to get much support from him, that he seems to have had a Damascene conversion since taking up the job of chair of the Health Select Committee. In an interview that he gave to the Times last year, he is quoted as saying that
“he wants an Office for Budget Responsibility-style body to keep his successors ‘honest’ by spelling out how many doctors and nurses are needed.”
The only problem with that conversion is that it fails to consider all the other types of staff that a sustainable health and care system needs, but it is better that he has moved some way towards accepting that there is a need for a body of this kind.
If we want a sustainable health and care system in the decades ahead, we need an independent office of health and care sustainability to do the long-term planning. History has shown that we cannot rely on the departments and their political heads, who are busy doing the day-to-day stuff, to take the time to plan for the future far ahead to sustain our health, our NHS and our adult social care system. I beg to move.

Lord Kakkar: My Lords, I declare an interest as a member of your Lordships’ ad hoc Select Committee on the Long-term Sustainability of the NHS. My noble friend Lord Warner has very clearly introduced the arguments summarised at that time, when your Lordships’ committee made its report, strongly supporting the establishment of an independent office for the sustainability of health and care, and I shall not repeat those arguments.
What was striking was Her Majesty’s Government’s response to that report and, indeed, to recommendations 32 to 34 in that report, which dealt with that specific question. To summarise, Her Majesty’s Government felt that that office was unnecessary and that the Office for National Statistics had much of the data publicly available to assist in this long-term planning activity. Clearly, that is not the case; it has not happened, and it is unlikely to happen.
It is essential, as we have heard, that such an office is established not only to deal with questions of workforce—my noble friend has identified the interview given by the right honourable Jeremy Hunt on the question of an independent office for questions of workforce—as sustainability of health and care goes far beyond workforce. A very careful and appropriately defined methodology and expertise needs to be brought together to ensure that we can plan on a definite basis and achieve the sustainability that every Member of your Lordships’ House clearly regards to be essential. I therefore hope that Her Majesty’s Government accept this amendment.

Baroness Merron: My Lords, five years have passed since the ad hoc Select Committee on the Long-term Sustainability of the NHS, under the chairpersonship of the noble Lord, Lord Patel,  recommended an office for health and care sustainability. I thank the noble Lord, Lord Warner, for bringing this amendment before your Lordships’ House. This is a clear direction to put sustainability at the heart of planning and is long overdue. So we on these Benches support the amendment, and I hope the Minister will accept this amendment as a way forward.

Baroness Penn: My Lords, I thank noble Lords for bringing this debate before the House today. As mentioned in the debate in Committee, the specific functions described in Amendment 112 are crucial functions that the Government are committed to ensuring are discharged. This commitment is underlined by the fact that there are already bodies and mechanisms in place to fulfil these functions. These are core components of the Government’s commitment to evidence-based health provision. This commitment has been made clear in many of the Bill’s provisions, in our wider programme of public health reform and in the proposals set out in the Government’s plan for health and care.
The amendment makes recommendations on both appraisal and scrutiny of funding and of social and demographic trends. With regard to the monitoring of trends, the department already publishes data relating to disease profiles, which incorporates demographic trends where relevant. This is supported by independent academic modelling from the Care Policy Evaluation Centre, CPEC, to produce projections of the long-term demand on adult social care services. As for funding, noble Lords will also be aware that successive Governments have used the well-established spending review process to set public service budgets. This takes into account the needs of service users, but crucially also considers the fiscal context and how healthcare expenditure balances with the range of priorities across government.
As noble Lords have noted, aligned to those spending decisions, the Office for Budget Responsibility already scrutinises the Government’s fiscal approach and our management of fiscal risks. For example, in October 2021 the OBR provided an independent analysis of the Government’s reform to the funding of adult social care in England and has announced that it will provide more analysis of the long-term implications in its next fiscal sustainability report. There is also, as noble Lords will know, a wide range of highly influential non-governmental bodies dedicated to the kinds of functions proposed for this new body—the King’s Fund, the Health Foundation and the Nuffield Trust to name just three. All of these contribute richly to the public debate on financial sustainability and on the size and composition of the workforce, as well as other related issues, and to the ability of this House to scrutinise government decisions on spending and policy.
The Government therefore do not think that the creation of a further body would add value. At this crucial time for the health and care system, we must proceed with the reforms we have outlined. For these reasons I hope that the noble Lord, Lord Warner, will feel able to withdraw his amendment.

Lord Warner: My Lords, no chance. I wish to test the opinion of the House.
Ayes 80, Noes 91.

Amendment 112 disagreed.
Consideration on Report adjourned.
House adjourned at 7.05 pm.